Design
The
design of any treatment program must be congruent with the type
of disease involved; that is, one must consider the particular characteristics
of the disease and implement strategies to address them. Chemical
Dependency has four characteristics: First, it is chronic which means it is permanent and prone to relapse. The disease for
abnormal drinkers is called alcohol-ism, not alcohol-wasm! This
implies that there is never a return to normal "social"
drinking or any "recreational" drug use. Relapse means
reactivation of the original disease, not acquisition of some new
disease. To prevent relapse, one must implement a defense against
the first drink or drug, and build an ongoing maintenance program
strong enough to countermand any alcohol craving or drug hunger.
Secondly,
it is primary which means
it exists independently and is not secondary to some underlying
other primary mental illness or personality disorder. Therefore,
the addiction must be treated directly with measures distinctly
different from the kinds of psychotherapy utilized for mental illness
in general. These measures are not designed to empower one to return
to social drinking, or develop insight into why one drinks. Total
abstinence from all addictive chemicals is the core goal central
to this approach. If there is a co-existing mental illness, called
a "dual diagnosis" situation, then it is considered also
as another primary disease and treated accordingly.
Thirdly,
addiction is predictable.
It is most often progressive with four stages: early-middle-late-and
too late! Its consistent reproducibility offers only three options
to its victims: they wind up either locked up (incarcerated), covered up (buried), or they sober up (get into recovery).
Lastly,
chemical dependency is contagious. Its insanity is contagious. The stress of living with an
alcoholic/addict produces dysfunctional coping behavior similar
to that seen in Post-Traumatic Stress Syndrome. Co-dependent family
members often remark that they have lived through a "thousand
Vietnams." Addiction is a family affliction, and therefore,
any quality treatment program should have a strong family component.
Top
Of Page
Philosophy
The
HIMS program approves treatment programs with certain components,
including, but not limited to:
| • |
A
full-time certified Physician-Addictionist |
| • |
Credentialed
&/or certified Counselors, some of whom are in substantial recovery
themselves |
| • |
Acceptance
of addiction as a primary disease |
| • |
Insistence
on total abstinence |
| • |
Separation
of alcoholic/addict patients from primary psychiatric patients |
| • |
Psychiatry
& Psychology Consultants |
| • |
A
strong family component |
| • |
Recovery
based on the 12-Steps of Alcoholics Anonymous |
| • |
Endorsement
by accreditation or licensure agencies |
Top
Of Page
Approach
Therapy
involves a tri-dimensional approach because body, mind, and soul
are compromised. Detoxification and medical stabilization by the
medical team occur first. Emotional balancing and cognitive restructuring
follow and are accomplished by the counseling staff.
Finally,
spiritual restoration begins with early exposure to Alcoholics and
Narcotics Anonymous, which are mutual-help fellowships and a 12-Step
program. Initiating abstinence is merely the beginning rather than
the end of recovery. Making the changes in attitude, belief system,
and habits necessary for the maintenance and growth of sobriety
creates real struggles. The critical challenge is to make the transition
from dry to sober and from clean to serene!
Top
Of Page
Entry
Rarely
does a pilot enter treatment completely voluntarily; most arrive
because of some type of "benevolent persuasion!" Many
believe their job is threatened. This endangers their entire sense
of being and identity. To lose their license and be denied flying
would shake the very foundation of their universe. They enter with
great suspicion. Pilots immediately set forth to complete the "check
list," memorize the "manual," follow all "procedures,"
comply with all "rules," stay within the "envelope,"
pass the counselor's "check ride," and maintain the proper
"glide path" to recovery. However, communicating on an
intimate emotional level and becoming truly engaged in therapy takes
an enormous effort.
Top
Of Page
Goals
Treatment
involves accomplishing many goals:
•
Penetrating denial
• Understanding the disease concept
• Reconnecting anesthetized feelings
• Identifying core (personal) issues
• Involving the family
• Developing relapse prevention strategies
• Inculcating Alcoholics/Narcotics Anonymous
Top
Of Page
Modalities
When
behavior is caused by disease, treating the disease changes the
behavior! The old "28 day" model is an endangered species.
Today's state-of-the-art medical approach matches the intensity
of the service to the severity of the illness. This applies to any
disease. Not all Diabetes is the same-there's mild, moderate, and
severe, each requiring different treatment-diet, pills, or insulin
replacement. The same is true for chemical dependency-outpatient,
in-patient, or extended residential modalities are utilized. Pilots,
like Physicians, are often subjected to more strenuous approaches
because of their safety-sensitive occupations. Nevertheless, individualized
treatment planning is utilized to treat professional pilots.
Top
Of Page
Special
Issues
Are
pilots different, and do they require specialized treatment? There
has been speculation that pilots have "giant egos," that
they are over-controlling, and are subjected to some very unique
stresses: irregular and extended hours, intermittent down-time,
repetitive family disruption, altered physiology from time zone
changes, sleep deprivation, and constantly operating under heightened
vigilance waiting for some catastrophic disaster. This remains speculative.
There is no current evidence to suggest these stresses differ from
other occupations, and the role of stress in addiction is also unclear.
Answers to these questions await further scientific inquiry.
Top
Of Page
Myths
Two
myths persist regarding treatment: 1) the alcoholic/addict must want treatment; and,
2) he or she must hit bottom!
Both are untrue and can be circumvented by a process called intervention--a
compassionate, rehearsed, professionally facilitated, non-judgmental
confrontation that essentially raises the bottom through benevolent
persuasion.
Top
Of Page
Change
There
are also some myths about change: namely, that change is easy;
it just takes will power; some just can't change;
and change involves action only. In reality, there are several
stages of change:
• Pre-contemplation: "I've
got a problem, but I don't think about it."
• Contemplation: "I'm thinking about the fact I've got a problem."
• Preparation: "Gee,
this is a problem, and I've got to do something about it,"
• Action: "I've
got a problem, but now I'm doing something about it."
• Maintenance: "The
problem is still here, so I've got to keep it under control."
Treatment
is about motivating patients to change. The treatment team facilitates
moving through the above stages. Responsibility for doing so is
quickly thrust upon the alcoholic/addict. Therapy involves connecting
the intellect with emotions. It necessitates abandoning isolation
by establishing a sense of community. It requires acquisition of
certain management skills, developing an accurate self-awareness,
and above all, experiencing ego reduction at depth.
Top
Of Page
Success
Outcome
studies show that the highest treatment success rates occur in the
professional population, especially with commercial pilots. Rehabilitation,
rather than termination, should be the ultimate goal, since it is
much more cost effective to treat rather than replace a highly skilled
pilot. Commercial airline pilots enjoy a significantly higher than
average success rate, and in recovery, constitute a valuable asset
to their profession and to the flying public.
Top
Of Page
References:
- Lewis, D.C. A Disease Model of Addiction. In N. S. Miller
and MC Doot (eds.) Principles of Addiction Medicine (1994). Chevy
Chase, Maryland. American Society of Addiction Medicine, Section 1,
Chapter 7, Pages 1-8.
- Hankes, LR, and Bissell, L. In Lowinson, Ruiz, Millman, (eds.) Substance
Abuse, A Comprehensive Textbook. Baltimore, Maryland: Willams and
Wilkins, 1992: 897-908. |
