Human Intervention Motivation Study

The Human Intervention Motivation Study (HIMS) is a United States aviation program that coordinates the identification, treatment, monitoring, and return-to-duty process for aviation professionals with substance use disorders or other conditions requiring FAA special issuance medical certificate review. FAA medical certification is required for pilots, air traffic controllers, flight engineers, flight navigators, and other aviation personnel.^[1] While originally developed for airline pilots, HIMS evaluations and monitoring are performed on all certificate holders requiring FAA medical clearance, including air traffic controllers (ATCs) and Aviation Safety Inspectors (ASIs).^[2] Established in 1974 with support from the Federal Aviation Administration (FAA), the Air Line Pilots Association, International (ALPA), and funding from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), HIMS has expanded to include pathways for post-traumatic stress disorder and attention deficit hyperactivity disorder.^[3]

The FAA describes HIMS as "an effective program that allows safety-sensitive employees to return to work in a safe and structured manner," and the program is supported by major airlines, pilot unions, and aviation industry organizations.^[4] As of 2021, approximately 12,000 pilots have been returned to flying under HIMS supervision since the program's inception.^[5] However, a 2023 consensus study by the National Academies of Sciences, Engineering, and Medicine, commissioned by Congress under the FAA Reauthorization Act of 2018, found "no solid evidence to support HIMS's claims of success" after the FAA and ALPA declined to provide requested data on program outcomes.^[6] Dr. Richard G. Frank, chair of the study committee, stated that HIMS "doesn't look that great" and the program's refusal to allow scrutiny "made me less sanguine about flying."^[7] In the official press release accompanying the report, Frank emphasized: "Collecting and maintaining reliable data will be the first step in allowing the FAA to improve these substance misuse programs."^[8]

The program requires participants to undergo monitoring including random drug and alcohol testing using ethyl glucuronide (EtG) and phosphatidylethanol (PEth) biomarkers, attendance at peer support meetings, and oversight by specially designated Aviation Medical Examiners. Testing costs are borne by participants, with first-year expenses ranging from $8,000 to $15,000.^[2] The Substance Abuse and Mental Health Services Administration (SAMHSA) has warned that EtG tests "should not be used as the sole basis for legal or disciplinary action."^[9] Several legal cases have addressed program-related practices, including Petitt v. Delta Air Lines (2022), in which an Administrative Law Judge ruled that Delta had "weaponized" psychiatric evaluations against a pilot whistleblower.^[10] The HIMS model has been adopted internationally in Australia, New Zealand, Hong Kong, and several European countries.^[11]

History

HIMS originated in 1974 when the Air Line Pilots Association received a grant from the National Institute on Alcohol Abuse and Alcoholism to develop an occupational alcoholism program for pilots.^[12] Working in cooperation with the FAA and airline management, ALPA developed a prototype program initially targeting alcohol misuse among pilots through structured treatment. The program was founded on the premise that pilot susceptibility to alcohol dependence was no different from other professional groups, but traditional workplace intervention methods were ineffective for pilots due to their high degree of autonomy and the difficulty of detecting performance issues in the cockpit environment.^[13]

The FAA joined the initiative by developing evaluation and monitoring procedures that enabled pilots who achieved adequate recovery to return to flying through special issuance authorization. This cooperative tripartite system among pilots, airline management, and the FAA became the foundation for HIMS operations.^[12]

The program operated under this informal cooperative structure for over three decades before undergoing significant expansion. In April 2010, the FAA reversed a nearly 70-year ban on pilots taking antidepressants, announcing that pilots with mild to moderate depression could fly while taking certain selective serotonin reuptake inhibitors if they demonstrated successful treatment for at least 12 months. The policy change, which the FAA said was designed to "change the culture and remove the stigma" associated with depression, expanded the role of HIMS AMEs to oversee monitoring and evaluation of pilots treated with approved psychiatric medications.^[14][15]

By 2018, HIMS had grown from a pilot alcohol program to a broader aeromedical certification pathway, prompting Congress to formally authorize the program and mandate independent review. The FAA Reauthorization Act of 2018 included Section 554, based on legislation authored by Senator Jeanne Shaheen (D-NH) called the "Transportation Workforce Recovery and Retention Act," which permanently authorized HIMS and mandated that the National Academies of Sciences, Engineering, and Medicine conduct an independent study of the program's effectiveness.^[16][17] When the National Academies committee attempted to conduct this congressionally mandated study, the FAA and ALPA declined to provide requested outcome data, leading the committee to conclude there was "no solid evidence to support HIMS's claims of success."^[3]

Despite the FAA's and ALPA's refusal to provide data for independent verification, program stakeholders continued to publicly assert high success rates. The FAA, ALPA, HIMS AMEs, and aviation industry publications consistently cited approximately 85 to 90 percent long-term sobriety rates.^[18][19] These figures originated from ALPA's own reporting dating to the 1980s, with program officials stating that "85 to 90 percent will have remained sober at the two-year mark."^[19] However, the National Academies noted that without access to the underlying data, the committee could not "resolve questions that arose during the study about the quality of HIMS data and data systems."^[20]

The National Academies also identified a significant gap between program participation and estimated need: HIMS treats roughly 1.5 percent of pilots, while published research literature suggests 13 to 15 percent of pilots may have a substance use disorder. The study attributed this gap in part to pilots' reluctance to disclose conditions due to concerns about career consequences, a finding later echoed by the FAA's own Mental Health Aviation Rulemaking Committee, which identified fear of certificate loss as "the most prevalent and serious barrier" to pilots seeking treatment.^[3][21]

Economic justification and coercion model

According to program materials, by the close of the initial eight-year federally funded project in 1982, HIMS had returned 800 pilots to the cockpit with an 85 percent long-term abstinence rate. The program reported a cost-benefit analysis showing a nine-to-one return on investment for every dollar spent on treatment, a figure subsequently cited to promote the program to airlines and policymakers.^[22]

Program officials have acknowledged that these outcomes depend significantly on the coercive leverage employers hold over participants. In a 2017 CBS News interview, Dr. Lynn Hankes, who ran an addiction treatment center in South Miami that treated pilots through HIMS, explained that the program's success rates cannot be replicated in the general public because "we don't have the leverage." Hankes stated: "If you threaten a pilot with taking away his wings, it's like threatening a doctor with taking away his stethoscope. That's a lot of leverage. If they want to get back to the cockpit or the operating room, they gotta jump through the hoops."^[23]

Critics have argued that this leverage model creates perverse incentives that may compromise aviation safety culture. In Petitt v. Delta Air Lines, Administrative Law Judge Scott Morris ruled it "improper for [Delta] to weaponize this process for the purposes of obtaining blind compliance by its pilots due to fear that Respondent can ruin their career by such cavalier use of this tool of last resort."^[10] Aviation attorneys have characterized the system as enabling airlines to use psychiatric evaluations as "an HR backboard and litigation shield" to manage pilots who raise safety concerns.^[24]

The underlying data for these original ROI and success rate claims was never made available for independent verification. When Congress mandated review in 2018, neither the FAA nor ALPA provided the requested outcome data to the National Academies study committee, which ultimately found the claims unverifiable.^[3][20]

The coercion model Hankes described is not unique to aviation. Similar concerns have been raised about state-run physician health programs (PHPs) that monitor healthcare workers for substance use disorders. In October 2025, a physician and ten nurses filed a federal class action lawsuit against Montana's monitoring program contractor, Maximus, alleging "punitive, expensive, and clinically unwarranted" practices including excessive monitoring, costly tests not clinically indicated, and lack of meaningful appeals. The lawsuit also alleged that one program participant died by suicide in January 2025 and that the contractor did not appropriately report the incident.^[25] A 2022 study in the American Journal on Addictions found that while 85 percent of physicians viewed their PHP experience favorably five years after completing it, out-of-pocket costs ranged from $250 to $321,000.^[26]

The structural similarities between HIMS and physician health programs are not coincidental. According to the HIMS program website, "PHPs grew out of the HIMS programs and both look to the other to adopt better strategies for maintaining long-term sobriety."^[27] Dr. Hankes, who explained HIMS's reliance on coercive leverage in the CBS interview, also served as president of the Federation of State Physician Health Programs.^[23]

Documented concerns in professional monitoring programs

Issue	Montana PHP Lawsuit (2025)	HIMS Program (documented)
Coercive leverage	Plaintiffs allege contractor "placed profit ahead of participant safety and recovery" by imposing requirements that were "not evidence-based"[25]	Dr. Lynn Hankes (CBS News, 2017): "If you threaten a pilot with taking away his wings, it's like threatening a doctor with taking away his stethoscope. That's a lot of leverage."[23]
Identity and fear	Dr. Chris Thacker, plaintiff: "The thing that has been most heartbreaking for me... is how much fear there has been among participants"; noted that having a license is "part of who we are, is part of our identity, and we're willing to do just about anything to keep it"[28]	Pilot in peer-reviewed study: "You are constantly worried about not only losing the certificate in your pocket and the ability to feed your family, but... you're going to lose your identity, and that fear is so strong that it just, it tears you apart"[29]
Monitoring duration	"Punitive" and "clinically unwarranted" monitoring; lawsuit alleges "keeping participants in the program for indefinite periods without clinically-justified extensions"[30]	Lifetime monitoring policy (2020); daily breath testing potentially for entire career; seven-year minimum monitoring period before step-down[31][27]
Testing concerns	Lawsuit alleges participants paid "$300 for one drug test, followed by additional tests in the same week," practices "not clinically indicated and unnecessary" and "potentially for financial gain"[30]	Uses EtG and PEth tests SAMHSA warned "should not be used as the sole basis for legal or disciplinary action"; FAA requires minimum 14 urine tests annually for first four years[9][27]
Appeal and transparency	"Lack of meaningful appeals"; lawsuit alleges contractor was "shielding documents and records from review"[25][30]	Limited ability to change HIMS AME for seven years; National Academies denied access to outcome data; study chair stated HIMS "did not really want to have a lot of scrutiny"[31][32][7]
Profit motive	Harvard researcher Dr. J. Wesley Boyd, MD, PhD: "Injecting the profit motive into a situation where folks generally have no choice but to comply with any and every recommendation you make if they want to be able to continue practicing is a recipe for abusive practices"[25]	Commercial HIMS AME practices access outcome data not provided to Congress; some practices require cash payment only and do not accept insurance[33][34]
Program atmosphere	August 2025 state audit: participants described program as "punitive rather than supportive"[30]	ALJ Morris ruling: "improper for [Delta] to weaponize this process for the purposes of obtaining blind compliance by its pilots due to fear"[10]
Cost burden	$250–$321,000 out-of-pocket per 2022 study; one nurse reported paying $26,000 in fees[25][26]	$8,000–$15,000+ first year; does not include treatment, psychiatric evaluations, or travel expenses[2][34]
Suicide concerns	Amy Young, Billings nurse, died by suicide in January 2025, the day after licensing board finalized terms of her suspension; family said she "felt hopeless about complying with the stringent program for years and its financial strain"[35]	Fear of disclosure linked to pilot suicides; FAA Mental Health ARC identified fear of certificate loss as "the most prevalent and serious barrier" to seeking treatment[36][37][21]

Program structure

HIMS coordinates the identification, treatment, and return-to-work process for pilots with substance use disorders or other conditions. The program requires pilots to work with specially designated Aviation Medical Examiners (AMEs) known as HIMS AMEs who have completed additional training and are approved by the FAA to supervise cases.^[18] However, access to qualified HIMS AMEs is limited. As of 2019, only 204 of approximately 2,500 AMEs nationwide were certified as HIMS AMEs, and according to the FAA, only 48 of those handled the majority of HIMS cases (six or more annually).^[33] The limited number of active HIMS AMEs has been identified as a barrier to program access, particularly for pilots in rural areas or those employed by companies without established HIMS programs.^[38]

Once assigned a HIMS AME, pilots have limited ability to change providers. FAA policy requires pilots to remain with the same HIMS AME for at least the first seven years after initial certification, with the stated purpose of providing "continuity and familiarity" and preventing pilots from "doctor shopping."^[31] Transferring to a different HIMS AME requires formal FAA approval and, in some cases, approval from the Federal Air Surgeon.^[32]

Support and endorsements

The FAA describes HIMS as "an effective program that allows safety-sensitive employees to return to work in a safe and structured manner."^[4] ALPA has cited the program's return-to-duty success rates in congressional testimony, presenting HIMS as a cornerstone of aviation safety policy.^[39]

As of 2021, Federal Air Surgeon Dr. Susan Northrup reported approximately 3,000 individuals were in the HIMS monitoring program, with 12,000 pilots having been returned to flying under supervision since inception. Northrup characterized the program's "incredible success rate" and observed that prior to HIMS, "a pilot with a diagnosis of a substance abuse or addiction was done. They didn't go back to flying."^[5]

Industry stakeholders have defended the program's structure as necessary for aviation safety. Airlines for America, the trade association representing major U.S. airlines, has supported HIMS as part of comprehensive aviation safety programs.^[40] The National Business Aviation Association has endorsed structured return-to-duty programs, and the program has received support in congressional testimony from both labor and management representatives.^[41] Proponents argue that the monitoring requirements, while demanding, provide accountability that benefits both pilots in recovery and public safety.

The FAA's 2024 Mental Health Aviation Rulemaking Committee, while recommending reforms to address barriers to treatment-seeking, affirmed the value of structured return-to-duty programs for aviation professionals with substance use disorders. The committee's recommendations focused on reducing stigma and improving access rather than eliminating monitoring requirements.^[21]

A 2022 study in the American Journal on Addictions examining physician health programs—which share structural similarities with HIMS—found that 85 percent of physicians viewed their monitoring experience favorably five years after completing it, suggesting that participants may ultimately value the structure even when finding it burdensome during participation.^[26]

Standard program requirements typically include:

• Initial evaluation and treatment, often including inpatient rehabilitation
• Regular attendance at peer support meetings (traditionally Alcoholics Anonymous)
• Ongoing psychiatric and psychological evaluations
• Random drug and alcohol testing (typically 14 tests per 12-month period)
• Quarterly meetings with a HIMS AME
• Monthly meetings with peer and company sponsors^[38]

Structural concerns

The combination of limited HIMS AME availability and switching restrictions has raised concerns about potential conflicts of interest and abuse. The National Academies noted that HIMS implementation is "highly decentralized," with individual airlines and unions having "considerable autonomy in how they carry out the expectations of the program."^[42] The study observed that "the company often maintains the managerial functions" of HIMS, creating a structure in which the same airline that may seek to terminate a pilot also plays a significant role in the pilot's psychiatric monitoring.^[42]

Critics have raised concerns that this structure could enable airlines to misuse psychiatric evaluations against pilots who raise safety concerns or are otherwise considered "problem" employees. In 2022, a federal Administrative Law Judge ruled that Delta Air Lines had "weaponized" the psychiatric evaluation process against Dr. Karlene Petitt, PhD, a Delta pilot with a doctorate in aviation safety from Embry–Riddle Aeronautical University, after she raised safety concerns about pilot fatigue, training records, and FAA compliance issues.^[10][43] The judge found it "improper for [Delta] to weaponize this process for the purposes of obtaining blind compliance by its pilots" and ordered the airline to pay $500,000 in damages.^[10] The case resulted in Delta being ordered to publish the court's findings to all 13,500 of its pilots.^[44] Dr. Petitt's attorney, who has represented over 50 aviation industry whistleblowers, described Delta's conduct as "Soviet-style psychiatric examination" used to silence safety concerns, and characterized the case as "an ugly war of attrition."^[10]

The Delta executive who approved the psychiatric referral, Stephen Dickson, was subsequently nominated by President Donald Trump to serve as FAA Administrator. Senator Maria Cantwell (D-WA) opposed his confirmation, citing the Petitt case as evidence of problems with airline safety culture.^[45] Dickson was confirmed 52-40 but resigned as FAA Administrator in March 2022, several months before the Department of Labor's Administrative Review Board affirmed the ruling against Delta in August 2022.^[10]

Peer monitoring and clinical decision-making

The HIMS program acknowledges "much subjectivity in the monitoring of pilots in recovery" and identifies peer pilots as "the most critical component of the subjective monitoring process."^[27] Program guidance states that peer monitor reports are "not expected to meet clinical standards, but rather [are] a layman's report on the behavior of the HIMS pilot."^[27] At a 2003 HIMS seminar, Captain Chris Storbeck, then-chairman of the Delta Pilots Assistance Committee, instructed peer pilot committee members to "trust their intuition when involved in identifying cases of substance abuse."^[46]

The program guidance explicitly states that "the peer pilot cannot provide privacy, privilege, or anonymity to the HIMS pilot" and that peers have "a responsibility to communicate with other people involved in the pilot's recovery including the pilot's supervisor and the HIMS AME."^[27] The National Academies confirmed that these peer reports are "included in the pilot's submission package for Special Issuance" to the FAA.^[42]

Critics have raised concerns that this structure—in which subjective, non-clinical peer assessments based on "intuition" flow directly into FAA certification decisions without apparent mechanism for pilot review or challenge—creates potential for abuse, particularly given the National Academies' finding that airlines "often maintain the managerial functions" of HIMS monitoring for their own pilots.^[42]

Coercive compliance and safety implications

Aviation safety attorneys and reform advocates have criticized the HIMS monitoring structure for creating a coercive environment in which any member of a pilot's monitoring team—including peer monitors, company supervisors, HIMS AMEs, treatment providers, and testing facilities—can effectively initiate processes that may result in career termination by submitting negative reports.^[38][27] Because pilots typically do not know the source or content of reports about them and have no mechanism to review or challenge these reports before they are included in FAA certification packages, critics argue the system creates pressure for "blind compliance" rather than genuine recovery.^[10]

Aviation safety experts have noted that a punitive or fear-based environment undermines safety reporting. The Flight Safety Foundation has stated that "accidents will be prevented and further improvements in aviation safety will be gained if people, particularly pilots, are protected from punitive action."^[47] Aviation attorney Lee Seham, who has represented approximately 50 to 60 aviation industry whistleblowers, characterized psychiatric evaluation processes used against pilots as "Soviet-style" and warned: "You can't have a safe airline if pilots are afraid."^[10]

Privacy protections and collective bargaining

Peer monitors and employers are not covered entities under the Health Insurance Portability and Accountability Act (HIPAA), meaning health information shared with them lacks federal privacy protection.^[48] Employment records are explicitly excluded from HIPAA's protections.^[49]

Collective bargaining agreements govern aspects of HIMS program structure at unionized carriers, but these vary by airline. The National Academies noted that individual airlines and unions have "considerable autonomy in how they carry out the expectations of the program," resulting in differing monitoring requirements, appeal procedures, and protections across carriers.^[42] Pilots must comply with airline-determined monitoring requirements—including who conducts evaluations, when and where testing occurs, and how long monitoring continues—with limited ability to refuse or negotiate terms while remaining employed.^[38][42]

Criticism and reform efforts

HIMS program stakeholder structure and data accountability based on 2023 National Academies findings.^[3]

Lack of data transparency

The National Academies' 2023 study documented significant barriers to evaluating HIMS effectiveness. The study noted that there was "a presumption advanced by the FAA and the Congressional sponsors of the study that HIMS and FADAP were model programs that could serve as the basis for other drug and alcohol treatment programs in the transportation sector." However, the committee found that "(1) the lack of information made available to the committee... would limit the ability of the committee to execute the charge; (2) what information was available to the committee created uncertainty regarding the claims about the success of the programs."^[50]

The FAA and ALPA refused to provide certain datasets on HIMS participation and outcomes despite the congressional mandate in Section 554 of the FAA Reauthorization Act of 2018. Appendix C of the National Academies report reproduces the complete chronology of communications between the committee and FAA, HIMS, ALPA, and congressional staff documenting the refusals:^[51]

• On April 27, 2022, the HIMS Program Manager initially offered to share queries and results from the HIMS database and set up a confidentiality data-sharing agreement, but no response was provided to the committee.
• On November 3, 2022, the committee requested data from the FAA-funded HIMS database. The HIMS Advisory Board denied access, "asserting the contract with the FAA and concerns over confidentiality and data disclosure might erode program integrity."
• On November 9, 2022, the committee again requested access to the HIMS database. ALPA "asserted the contract with HIMS restricted access to the database."
• On December 2, 2022, the committee requested custom language so ALPA could run queries by their staff to assuage confidentiality concerns. ALPA "asserted sophisticated searches may not result in accurate or reliable results." No data was received.
• On December 6, 2022, Senator Shaheen's staff contacted ALPA representatives to allow the committee access to HIMS data. ALPA "asserted that lack of standardized data might lead to inaccurate results and negatively affect analysis."
• On December 14, 2022, the committee and Senator Shaheen's office received a copy of the FAA-ALPA contract for HIMS.
• On December 15, 2022, after review of the contract, the committee noted that "the FAA owned the data, not ALPA," and indicated that access to the data would assist the National Academies to fulfill the congressional mandate.
• On December 21, 2022, the FAA "noted that full access would not be provided" and offered to make available aggregate data related to HIMS.
• On January 30, 2023, the committee asserted its request for HIMS data. Data was not received.
• On February 3, 2023, Senator Shaheen's staff noted the lack of cooperation and access to the data and would inform future possible actions with regard to the HIMS database.

The study noted: "Those aggregate data were never delivered."^[20][51]

The study further noted that "the committee never received indications that HIMS and its administering organization, Air Line Pilots Association–International (ALPA), ever distributed the link or sought pilot participation" in the study's data collection efforts. The committee's "Call for Perspectives" tool received 1,200 total responses, but only 4 were from pilots.^[51]

The National Academies highlighted that this participation gap has policy implications, noting that HIMS's own internal estimates suggested 8 to 12 percent of pilots may have substance use disorders—figures the committee observed were still "lower than the 13 to 15 percent derived from the research literature." The committee concluded: "The troubling implication of this is that the FAA and Congress have limited visibility of the degree to which pilots with substance misuse problems are being treated."^[50]

The study also found that existing screening procedures yielded low identification rates: "existing screenings are yielding rates of 0.5 percent from aviation medical examiners (AME's) annual examinations, when general screening rates are typically greater than 14 percent."^[50]

Lack of publicly verifiable outcome data

Despite apparently collecting HIMS case data through electronic systems available to HIMS AMEs since at least April 2011, the FAA does not publish aggregated HIMS program outcome statistics in any publicly accessible format.^[33][52] The 2023 National Academies study documented that neither the FAA nor ALPA provided comprehensive outcome data for evaluation despite the congressional mandate to conduct an independent review.^[3]

Some commercial HIMS AME practices have published statistics claiming to derive from FAA data sources. Kansas Aviation Medicine, a private HIMS AME practice, states on its website that FAA data from April 2011 through October 2019 shows 1,162 individual first-class certificate holders involved in HIMS, with an 85 percent sustained abstinence rate, 12.7 percent experiencing a single relapse, and 3 percent experiencing two or more relapses.^[33] However, no citation to any publicly accessible FAA publication or database is provided, and these statistics cannot be independently verified through any public FAA resource.^[52]

Reform advocates have noted that commercial HIMS AME practices—which have financial interests in presenting the program favorably to prospective clients—appear to access HIMS outcome data that was not provided to the congressionally mandated National Academies study committee. This suggests that outcome data exists and is being collected, but has not been made available for independent public scrutiny.^[33][3]

The FAA's publicly available Aerospace Medical Certification Statistical Handbook provides counts of pilots with various medical conditions but does not include HIMS-specific outcome measures such as relapse rates, return-to-duty success rates, or long-term sobriety statistics.^[52]

Lifetime monitoring

In April 2020, the FAA implemented a policy establishing lifetime monitoring for pilots in the HIMS program. The FAA's September 2020 Step Down Plan establishes five phases over a minimum of seven years:^[31][53]

Phase	Duration	Key Requirements
Early Phase 1	Year 1	14 random tests annually, twice-weekly peer support attendance, quarterly AME visits
Intermediate Phase 2	Year 2	14 random tests annually, weekly peer support attendance
Advanced Phase 3	Years 3–4	14 random tests annually, weekly peer support attendance
Maintenance Phase 4	Years 5–7	Reduced testing frequency, no mandatory peer support meetings
Long-term Phase 5	Year 8+	Annual HIMS AME review only

These represent FAA minimum requirements; individual airlines may impose additional monitoring requirements as part of their company-specific HIMS programs, which vary between carriers.^[42]

However, the FAA guidance explicitly states that progression through phases is "NOT guaranteed" and represents only "nominal" and "uncomplicated" recovery, with the FAA—not the pilot's HIMS AME—retaining final authority on tier advancement.^[31][53] The Step Down Plan memorandum implementing this structure was addressed only to Aviation Medical Examiners and Regional Flight Surgeons rather than to pilots themselves.^[53] Aviation attorneys have characterized the step-down provisions as largely theoretical rather than practical. Critics argue lifetime monitoring disincentivizes pilots from voluntarily seeking treatment, as disclosure results in permanent FAA oversight regardless of recovery duration or severity of initial diagnosis.^[24]

Reliance on 12-step treatment

The FAA's program materials and certification requirements emphasize 12-Step Facilitation (TSF) and Alcoholics Anonymous-based treatment models. Reform advocates argue that this reliance discounts evidence about variable effectiveness and imposes a spiritually-based model on participants who may object on religious grounds. This issue was central to the EEOC's 2022 lawsuit against United Airlines on behalf of a Buddhist pilot.^[54]

Allegations of program misuse

Aviation attorneys and advocacy groups have alleged that some Part 121 carriers use HIMS referrals as what the AOPA Pilot Protection Services newsletter described as "an HR backboard and litigation shield" to manage problem employees or avoid wrongful termination claims.^[24] The Petitt v. Delta Air Lines case, discussed in detail in the Legal cases section below, resulted in a ruling that Delta had improperly used psychiatric evaluation processes against a pilot whistleblower.^[10]

Monitoring and privacy

The HIMS program website states that company supervisors maintain familiarity with participants' "on-duty performance and layover behavior," with concerns arising from non-work situations "to be taken very seriously."^[27]

Aviation attorneys and reform advocates have questioned how such monitoring is conducted and whether it conflicts with FAA rest regulations requiring pilot rest periods to be "free from all restraint by the certificate holder."^[55] Neither ALPA nor the FAA has publicly documented the specific methods used for monitoring HIMS participants during off-duty periods.

Testing protocols and cost burden

The abstinence testing mandated by the FAA for HIMS participants is distinct from DOT workplace testing programs and utilizes different methodologies. According to the official HIMS program, "abstinence testing mandated by the FAA is NOT DOT testing and does not count toward the employer's random testing program requirements."^[27] The FAA requires a minimum of 14 urine ethyl glucuronide (EtG) tests annually for the first four years, with testing frequency reduced to quarterly blood phosphatidylethanol (PEth) testing after sustained compliance.^[27]

Unlike DOT workplace testing, which requires positive results to be reviewed by a Medical Review Officer (MRO) who evaluates whether there is a legitimate medical explanation before reporting results to employers,^[56] HIMS abstinence testing results are reported directly to the HIMS AME without comparable independent medical review.^[27]

SAMHSA advisories on EtG testing

The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued multiple advisories warning against using EtG testing as a definitive measure of alcohol consumption. A 2006 SAMHSA advisory stated that using EtG as sole evidence of drinking is "scientifically unsupportable" and "should not be used as the sole basis for legal or disciplinary action."^[57] A 2012 revision reiterated that EtG/EtS are "highly sensitive" and can produce positive results after low-level incidental exposures, recommending that positive immunoassay results be confirmed by GC/MS or LC/MS/MS before being used in any consequential decision.^[9]

According to SAMHSA, the EtG test is "fine for use in clinical settings" but "should not be used as a stand-alone test in a forensic situation where someone's job is at stake."^[9] SAMHSA specifically warned that calling such a test "positive" for consumption or relapse, especially at low concentrations, "could have devastating consequences for someone who signs an alcohol abstinence contract or is required to be abstinent by law."^[9]

The EtG urine test used in HIMS monitoring has been shown in peer-reviewed research to produce false positive results from incidental alcohol exposure. A 2014 study published in Forensic Science International found that healthcare workers using alcohol-based hand sanitizer produced EtG levels exceeding clinical cutoffs even when completely abstinent from alcohol consumption, with the study concluding that "accidental ethanol inhalation can occur quite frequently in the working place" and "should always be considered when EtG is used as a marker of recent ethanol consumption."^[58] A separate 2012 study found that propanol-based hand sanitizers produced false-positive EtG immunoassay results through inhalation alone, leading the researchers to conclude that "positive EtG immunoassay results have to be controlled by mass-spectrometry."^[59]

In Erwin v. FAA (2021), the D.C. Circuit considered a pilot's challenge to a positive EtG test that resulted from unknowingly consuming food prepared in beer. The pilot submitted the SAMHSA advisory as evidence supporting his claim that the positive result was from incidental exposure rather than intentional consumption; the court remanded the case to the FAA for adequate explanation of its decision.^[60]

Non-FDA approved testing

Both the PEth and EtG tests used in HIMS monitoring are classified as Laboratory Developed Tests (LDTs), meaning the FDA does not verify their safety, effectiveness, or quality through premarket review.^[61] The tests are intended as screening tools requiring confirmatory testing, yet in HIMS they may be used as the basis for career-ending decisions without MRO review or mass spectrometry confirmation. Critics have raised concerns that pilots' careers can be terminated based on tests that SAMHSA has explicitly warned should not be used as the sole basis for such decisions.^[61][9]

PEth testing reliability

The HIMS program relies on phosphatidylethanol (PEth) testing to detect alcohol consumption, but the reliability of dried blood spot (DBS) PEth testing has been questioned in peer-reviewed research.

In July 2025, Dr. Karlene Petitt, PhD—the Delta Air Lines captain who prevailed in the Petitt v. Delta Air Lines whistleblower case—published a study in the Journal of Biomedical Science and Engineering demonstrating that the same blood sample, tested on the same day, could produce both negative and positive results depending on collection methodology.^[61] The study noted that DBS PEth testing is not FDA-approved and that United States Drug Testing Laboratories (USDTL) is the only commercial laboratory conducting DBS PEth testing used in HIMS monitoring.

Dr. Petitt's study found that 10 of 20 dried blood spot samples from a single abstinent subject tested positive for PEth, contradicting expert assertions that false positives were impossible. She acknowledged First Officer Michael Danford—the Delta pilot terminated in 2018 after disputing a positive PEth test (see Danford arbitration (2021) below)—"for shining light on false positive results," noting that his termination had been based in part on the arbitrator's finding that no peer-reviewed literature documented false positives at that time.^[61]

Separate peer-reviewed research has identified additional mechanisms for false positive PEth results. A 2022 study in Separations found that dried blood spot samples exposed to alcohol vapors from disinfectants during the drying process could produce positive results in abstinent individuals; researchers concluded that "each PEth-negative sample from a healthy male patient incubated in the presence of ethanol vapor becomes PEth-positive" and that "after 4 h of DBS drying, teetotalers become 'moderate drinkers.'"^[62]

A 2023 study in Clinical Biochemistry by researchers at Mayo Clinic documented that packed red blood cell transfusions can artificially elevate PEth to concentrations associated with moderate alcohol consumption in patients who tested negative prior to transfusion. The case study demonstrated PEth rising from undetectable levels (<10 ng/mL) to 57 ng/mL after transfusion of four packed red blood cell units, with researchers concluding that "pRBC transfusion can artificially elevate PEth into clinically and forensically relevant ranges."^[63]

Soberlink remote monitoring

In addition to laboratory testing, many HIMS participants are required to use Soberlink remote alcohol monitoring devices, which combine a portable breathalyzer with cellular transmission and facial recognition to verify identity. According to the HIMS program website, "breath testing is usually done several times a day on a daily basis."^[27] Research protocols for cellular portable daily breath (CPDB) devices specify testing four times daily: upon arising, after lunch, after dinner, and before bedtime.^[64]

Testing is required during both on-duty and off-duty time. The devices require cellular connectivity to transmit results, creating geographic limitations for pilots in remote areas without reliable cellular coverage; however, the devices can store tests when connectivity is unavailable and upload them when a connection is restored.^[65][64]

Under the FAA's lifetime monitoring policy implemented in 2020, pilots may be required to maintain daily breath testing for the duration of their flying careers, regardless of years of demonstrated abstinence or the severity of their initial diagnosis.^[27]

Cost burden

Pilots bear the financial burden of HIMS participation. The AOPA Pilot Protection Services newsletter characterized the HIMS process as "time consuming and expensive," noting that monitoring can last five to seven years depending on circumstances.^[38] Pilots who work for airlines without active HIMS programs, or who are self-employed, must fund the entire process themselves.^[66] One HIMS AME practice disclosed that the program requires cash payment only, with health insurance not accepted, listing fees including $4,000 for the first year of monitoring alone, exclusive of treatment, testing, psychiatric evaluations, and travel expenses.^[34]

Pilot advocacy groups have raised concerns about overcharging in a market with limited provider options. Some HIMS AMEs have been reported to charge $500 to $600 per hour for consultations, with total first-year costs for HIMS participation ranging from $8,000 to $15,000.^[2] These direct costs do not include the substantial income reduction pilots experience during grounding. A 2023 Department of Transportation Office of Inspector General report noted that pilots may experience "financial hardship if FAA's approval process extends beyond the pilot's prescribed disability benefit period."^[67] A 2025 Reuters investigation found that when pilots are grounded, "the financial fallout can be significant" as they are "often placed on disability, which can significantly reduce their income."^[37]

Fear of disclosure

The FAA's Mental Health Aviation Rulemaking Committee acknowledged in its April 2024 report that "fear of temporary or permanent certificate/clearance loss is the most prevalent and serious barrier" preventing aviation professionals from seeking mental health treatment. The committee identified seven overarching barriers and made 24 recommendations to address them.^[21]

In fall 2021, John Hauser, a 19-year-old aviation student at the University of North Dakota, died by suicide by intentionally crashing his training aircraft. In letters left to his family and friends, Hauser wrote that he was struggling with depression but feared seeking help would end his flying career. His suicide note included a request: "If you can do anything for me, try to change the FAA rules so that other young pilots don't have to go through what I went through." Hauser's parents, both physicians with psychiatric training, said they had no indication their son was depressed.^[36] Hauser's death became a catalyst for the Mental Health in Aviation Act, with his parents testifying before Congress about the need for reform.^[68]

A December 2025 Reuters investigation found that commercial airline pilots "often conceal mental health conditions for fear that disclosing therapy or medication, or even just seeking help, could mean having their license pulled." The investigation cited Delta pilot Brian Wittke, a 41-year-old father of three who died by suicide in June 2022 after refusing treatment because he was "terrified that getting treatment for depression would cost him his license and livelihood." Delta called Wittke's death "tragic and heartbreaking" and acknowledged stigma within the pilot community against seeking mental health services.^[37]

The Reuters investigation also documented the case of pilot Troy Merritt, who voluntarily grounded himself in December 2022 for depression and anxiety. Merritt told Reuters the recertification process cost him approximately $11,000 out-of-pocket for psychological and cognitive tests not covered by health insurance, and he was grounded for 18 months while living on disability insurance.^[37] A 2023 study of more than 5,000 U.S. and Canadian pilots found that over half said they avoided healthcare due to concerns about losing flying status, a phenomenon encapsulated in the industry maxim: "If you aren't lying, you aren't flying."^[37]

Legislative reform

In September 2025, the United States House of Representatives unanimously passed the Mental Health in Aviation Act of 2025 (H.R. 2591), which would require the FAA to implement recommendations from the Mental Health Aviation Rulemaking Committee within two years, revise regulations to encourage voluntary mental health disclosures, and provide funding to recruit and train additional aviation medical examiners including psychiatrists.^[69] The bill received endorsements from ALPA, Airlines for America, the National Air Traffic Controllers Association, and the National Business Aviation Association.^[41]

In November 2025, Senators John Hoeven (R-ND) and Tammy Duckworth (D-IL) introduced S.3257, the Senate companion to the Mental Health in Aviation Act. The Senate bill includes identical provisions requiring FAA implementation of rulemaking committee recommendations, annual review of mental health special issuance processes, and allocation of $15 million annually from fiscal years 2026 through 2029 for additional aviation medical examiners. The legislation has received bipartisan cosponsorship from twelve senators.^[70]

Legal cases

The following cases represent legal challenges to HIMS-related practices at major airlines. These cases have received coverage in reliable sources including federal court decisions, EEOC press releases, and major news outlets. Given the program's acknowledged reliance on coercive leverage over participants' careers,^[23] and the National Academies' finding that pilots avoid disclosure due to fear of career consequences,^[3] litigation may underrepresent the scope of concerns within the program. The cases document specific allegations that have been adjudicated or are pending in court.

Petitt v. Delta Air Lines (2016–2022)

Dr. Karlene Petitt, PhD, a Delta Air Lines captain with over 35 years of experience and a doctorate in aviation safety from Embry-Riddle Aeronautical University, filed a whistleblower complaint after alleging retaliation for raising safety concerns.^[10] In January 2016, Dr. Petitt submitted a 43-page safety report to Delta executives including Senior Vice President of Flight Operations Steve Dickson (later FAA Administrator) detailing concerns about pilot fatigue, training records, and safety management systems. Six days later, Delta Vice President of Flight Operations Jim Graham initiated a "Section 15" psychiatric referral.^[10]

Delta paid psychiatrist Dr. David Altman approximately $74,000 to evaluate Dr. Petitt. Altman diagnosed her with bipolar disorder, which grounded her. However, a panel of nine physicians from the Mayo Clinic's Aerospace Medicine Department unanimously concluded she did not have bipolar disorder or any psychiatric disorder. Dr. Lawrence Steinkraus of Mayo Clinic testified that Altman's diagnosis was "a puzzle for our group" and that "the evidence does not support presence of a psychiatric diagnosis but does support an organizational/corporate effort to remove this pilot from the rolls."^[10]

Altman later testified that his diagnosis was driven in part by Dr. Petitt's accomplishments, which he characterized as "well beyond what any woman I've ever met could do"—therefore suggestive she was manic.^[10]

In December 2020, Administrative Law Judge Scott Morris ruled Delta had "weaponized" the psychiatric evaluation process and awarded Dr. Petitt $500,000 in compensation—five times the highest previously recorded award under the whistleblower statute. Morris ordered Delta to prominently post copies of his decision at every pilot base.^[10] Altman forfeited his medical license in 2020 rather than face charges from the Illinois Department of Financial and Professional Regulation over his conduct in psychiatric exams of two Delta pilots.^[71] The case settled in October 2022.^[72]

EEOC v. United Airlines (Disbrow) (2020–2022)

In 2020, the U.S. Equal Employment Opportunity Commission filed suit on behalf of David Disbrow, a Buddhist pilot with 30 years of experience who had been diagnosed with alcohol dependency. Under United's HIMS program requirements, Disbrow was required to attend Alcoholics Anonymous meetings to regain FAA medical certification. Disbrow objected to the religious content of AA—including meetings held in churches, opening prayers, and acknowledgment of a "Higher Power"—and requested accommodation to attend Refuge Recovery, a Buddhism-based peer support group.^[54]

United refused the accommodation, and Disbrow was unable to obtain a new FAA medical certificate. In November 2022, United agreed to a consent decree paying $305,000 in back pay and damages, reinstating Disbrow into HIMS while allowing participation in a non-12-step program, and implementing policies to accept religious accommodation requests in HIMS going forward.^[54][73]

EEOC New York Regional Attorney Jeffrey Burstein stated: "Employers have the affirmative obligation to modify their policies to accommodate employees' religious beliefs. If they require their employees to attend AA as part of a rehabilitation program, they must make sure that they allow for alternatives for their employees who have religious objections to AA."^[54]

Erwin v. FAA (2021)

Charles Erwin, a commercial airline pilot participating in HIMS under a special issuance authorization contingent on "total abstinence from alcohol," tested positive on a random EtG test in December 2017. Erwin had eaten pulled pork at a Tennessee restaurant the previous day; the menu did not disclose that the dish was prepared in beer. The restaurant subsequently confirmed the pork was "in fact, cooked with beer." Erwin voluntarily submitted to PEth testing within days, which returned negative.^[60]

Erwin provided the FAA with evidence including the restaurant's confirmation, his negative follow-up tests, and a 2012 SAMHSA advisory cautioning against using EtG results as sole evidence of alcohol consumption. A toxicology expert concluded "within a reasonable degree of scientific certainty" that the positive result was from incidental exposure rather than intentional consumption. The FAA denied reconsideration without adequate explanation.^[60]

In December 2021, the U.S. Court of Appeals for the D.C. Circuit remanded the case, ruling that the FAA must provide the "why and wherefore" of its decision rather than simply asserting agency expertise. The court recognized that Erwin suffered a cognizable injury from his "poorer position in the HIMS Step Down Plan" and accompanying extended monitoring requirements resulting from the disputed test.^[60]

Tallon v. United Airlines (2025–ongoing)

In July 2025, Captain Michael Tallon, a United Airlines check airman with nearly 30 years of experience, filed a federal lawsuit alleging wrongful termination after a head injury was mischaracterized as alcoholism. According to the complaint, Tallon suffered a concussion during a June 2023 layover in the Azores after tripping on cobblestones. Despite exhibiting classic concussion symptoms including slurred speech and confusion, Tallon alleges United and ALPA pressured him to admit to alcoholism and enter the HIMS program rather than providing medical treatment for his head injury.^[74]

The complaint states that despite completing a month-long inpatient program and receiving multiple evaluations finding no alcohol dependency, Tallon remained in HIMS until his termination in February 2025 for refusing further compliance. The lawsuit alleges United saved millions in long-term disability payments by terminating Tallon through the HIMS program rather than providing a medical separation for his head injury. Tallon's attorney Mike Lueder described the system as "Kafkaesque."^[75] The case is ongoing.

Danford arbitration (2021)

First Officer Michael Danford, a Delta pilot and U.S. Naval Academy graduate with 18 years at Delta, was terminated in 2018 after disputing a positive PEth alcohol test. Danford maintained he had not consumed alcohol and presented three subsequent negative tests, but Delta required him to either undergo three to six months of inpatient treatment or face termination. The arbitration decision noted that his HIMS AME, chief pilot, and union representative all urged him to accept treatment regardless of whether he had actually relapsed. In February 2021, the arbitrator ruled for Delta, finding that just cause existed under the negotiated program protocols, while acknowledging "we can never be certain whether or not Danford was abstinent and simply had some false positives."^[76]

The FAA subsequently reissued Danford's first-class medical certificate without requiring inpatient treatment, determining that full consideration of clinical and testing data "cast doubt on the reliability" of the disputed test result.^[76]

In 2025, Dr. Petitt published peer-reviewed research in the Journal of Biomedical Science and Engineering demonstrating that false positive PEth test results can occur even with complete alcohol abstinence. Dr. Petitt acknowledged Danford in the paper "for shining light on false positive results," noting that his termination had been based in part on the arbitrator's finding that no peer-reviewed literature documented false positives.^[61]

Ratfield v. Delta Air Lines (2022–2024)

Captain Andrea Ratfield, a Delta pilot since 2007, filed suit in federal court alleging that Delta used HIMS referral and retreatment requirements as retaliation after she reported sexual harassment by male pilots. According to court filings, Ratfield sought help from a company supervisor to cope with trauma from sexual assault at an aviation event. She was directed to the HIMS program—a substance abuse program—rather than receiving trauma-focused support. The lawsuit alleged that Delta management subsequently used additional HIMS treatment requirements as retaliation for her harassment complaints. Ratfield's complaint also alleged that a PEth test administered during her monitoring was "non-controlled" and "notorious for its false positives."^[77]

In August 2023, Judge Katherine Menendez of the U.S. District Court for the District of Minnesota denied Delta's motion to dismiss, ruling that Ratfield "plausibly alleged that she had been subjected to 'a sexually hostile work environment emblematic of the good ol' boys club.'" The court rejected Delta's argument that retreatment requirements were "beneficial opportunities," finding that binding case law "indicates otherwise."^[77] The case was dismissed with prejudice in August 2024, indicating a settlement.^[78]

Barnard v. Kozarsky (2024–ongoing)

In August 2024, Captain Martin Barnard, a Delta pilot, filed a negligence lawsuit against Dr. Alan Kozarsky, an ophthalmologist serving as his HIMS AME. According to the complaint, Barnard had entered HIMS following a 2020 DUI, and in September 2021 the FAA granted him a special issuance first-class medical certificate. In October 2022, Barnard reported possibly consuming low-alcohol beer accidentally; a subsequent PEth test returned negative. Despite the negative result, Barnard alleges Kozarsky reported to the FAA that Barnard was experiencing "imperfect recovery" and presented an "increased risk for full relapse."^[79]

Delta subsequently demanded Barnard accept the diagnosis and undergo 98 days of inpatient treatment. Kozarsky moved to dismiss, arguing he had no doctor-patient relationship with Barnard and was exempt from liability as an FAA representative. The court denied the motion, ruling that "Mr. Barnard's complaint, accepted as true, plausibly alleges that it was foreseeable that Dr. Kozarsky's report would cause the FAA to revoke Barnard's medical license." The case is proceeding to discovery.^[80]

Castillo v. United Airlines (2025–ongoing)

In October 2025, John Paul Castillo III, a former U.S. Air Force combat pilot who joined United Airlines in January 2023, filed a federal lawsuit alleging racial discrimination, disability discrimination, and defamation. Castillo was arrested in July 2023 for suspected DUI based on a field sobriety test; no blood alcohol test was conducted, and the charges were later dismissed through pretrial diversion.^[81]

According to the complaint, United pressured Castillo to enroll in the HIMS program despite an independent psychiatric evaluation finding no alcohol-use disorder and describing the incident as "a one-off, aberrant event." When Castillo refused HIMS enrollment, United terminated him in November 2023, citing a temporary lapse of his FAA medical certificate. Castillo alleges that United's "perception of Mr. Castillo as an alcoholic was not a neutral medical judgment but reflected racialized stereotypes about Hispanic men and alcohol use," and that a white probationary pilot facing similar DUI charges remained employed because he joined the HIMS program.^[82] The lawsuit also alleges that United defamed Castillo by falsely reporting to the FAA that his termination was due to "pilot-performance issues."^[81] The case is pending.

Other controversies

Veterans Affairs data sharing

In August 2023, The Washington Post reported that the FAA was investigating approximately 4,800 pilots—including 600 licensed to fly passenger airliners—after cross-referencing pilot health information against a Veterans Affairs database. The pilots under scrutiny were military veterans who had failed to report, as required by law, that they were collecting veterans benefits for disabilities that could affect flight certification.^[83]

FAA medical staff determined that 60 of the flagged pilots "may have disqualifying conditions" and ordered them to "cease flying unless and until they obtain a new medical certificate or an Authorization for Special Issuance." The conditions included post-traumatic stress disorder, depression, and sleep apnea. The remaining pilots were offered a reconciliation process to correct their medical records, though the FAA declined to offer broad amnesty as the aviation industry had requested.^[84]

The VA data sharing raised privacy concerns among pilots, though the legal basis for such sharing was established in federal statute. Under 38 U.S.C. § 5701, VA records must be disclosed "[w]hen required by any department or other agency of the United States Government."^[85] The Health Insurance Portability and Accountability Act (HIPAA) does not restrict inter-agency sharing among federal entities, as federal agencies are not covered entities under HIPAA for information they hold in governmental capacity.^[86]

The 2023 investigation followed a similar 2004 effort called "Operation Safe Pilot," in which the FAA cross-referenced pilot medical certificates with Social Security Administration disability records. That investigation resulted in prosecutions and a legal challenge culminating in the 2012 U.S. Supreme Court case FAA v. Cooper, which addressed whether the Privacy Act of 1974 permits damages for emotional harm caused by improper disclosure of government records. The Court held that the Privacy Act's waiver of sovereign immunity does not extend to mental and emotional distress claims absent physical injury.^[87]

International expansion

The HIMS program model has been adopted by several countries as a framework for managing aviation professionals with substance use disorders. The U.S. HIMS program's official links page lists international aviation substance abuse programs including HIMS Australia, NZ HIMS, Lufthansa Antiskid (Germany), KLM Antiskid (Netherlands), and PAN HK (Cathay Pacific, Hong Kong).^[11]

International programs have generally cited approximately 85-90 percent success rates based on U.S. program statistics rather than country-specific outcome data.^[6] The 2023 National Academies study found "no solid evidence to support HIMS's claims of success" and noted that the committee "could not resolve questions that arose during the study about the quality of HIMS data and data systems" because the FAA and ALPA declined to provide requested outcome data for independent verification.^[3]

Hong Kong

Cathay Pacific in Hong Kong introduced a formal HIMS-modeled program in 2012, making it one of the earliest international adoptions of the U.S. framework.^[88]

New Zealand

HIMS New Zealand was established circa 2017 and is supported by Air New Zealand, Airways Corporation of New Zealand, the Royal New Zealand Air Force, and the New Zealand Air Line Pilots' Association, with endorsement from the Civil Aviation Authority of New Zealand.^[89] The program is described as "modelled on well-established overseas programmes" and claims to have "assisted thousands of pilots in getting back to work," though this figure appears to reference the U.S. program's historical totals rather than New Zealand-specific outcomes.^[89] According to HIMS Australia, "New Zealand is finding similar successes as the US," though no independent verification of New Zealand-specific outcomes has been published.^[88]

Australia

The HIMS Australia Advisory Group (HAAG) was formed circa 2015 as a collaborative body comprising representatives from professional pilot associations, Designated Aviation Medical Examiners (DAMEs), addiction medicine specialists, and psychologists.^[90] The catalyst for HIMS Australia's formation was a fatal 2002 accident at Hamilton Island, Queensland. On September 26, 2002, a Cherokee Six crashed shortly after takeoff, killing the pilot and five passengers.^[91] The Australian Transport Safety Bureau (ATSB) investigation found post-mortem toxicological examination revealed a blood alcohol concentration of 0.081%, an inactive metabolite of cannabis indicating prior use, and codeine/morphine/paracetamol consistent with the over-the-counter medication Panadeine.^[91] The ATSB concluded: "There was insufficient evidence to definitively link the pilot's prior intake of alcohol and/or cannabis with the occurrence. However, the adverse effects on pilot performance of post-alcohol impairment, recent cannabis use and fatigue could not be discounted as contributory factors."^[91] The accident investigation led to recommendations for the introduction of alcohol and other drug testing programs for safety-sensitive personnel, ultimately resulting in CASR Part 99 regulations approved in 2008.^[90]

The program is supported by the Australian Federation of Air Pilots and involves coordination with the Civil Aviation Safety Authority (CASA). HIMS Australia's FAQ states that "the success rates for this very complicated relapsing medical condition have been over 88% in the long term," explicitly citing U.S. program data rather than Australian outcomes, while acknowledging the program structure is being "tailored to suit the Australian environment."^[92]

Unlike the U.S. HIMS program, which operates as a "return to work" program integrated with airline management, HIMS Australia describes itself as a "peer support programme where trained peer supporters mentor pilots who have had AOD [alcohol or other drug] issues."^[93]

Europe

Several European airlines have established similar programs, including Lufthansa's Antiskid program (Germany), KLM's Antiskid program (Netherlands), and programs at airlines in France and Finland.^[88][11] The UK Civil Aviation Authority has participated in U.S. HIMS training seminars, with CAA medical officers attending to learn about certification approaches for pilots with substance use histories.^[94]

Public discourse

In August 2024, FX aired The New York Times Presents: Lie to Fly, a documentary examining pilot mental health issues, including the 2023 incident involving Alaska Airlines pilot Joseph Emerson.^[95]

Following the National Academies' 2023 report documenting the FAA and ALPA's refusal to provide program data, a broader ecosystem of pilot-led advocacy has emerged. These initiatives include nonprofit reform organizations, independent pilot experience surveys, alternative AME directories intended to address concerns about limited provider networks, and proposed evidence-based alternatives to the current HIMS model. Online forums, discussion boards, personal blogs by affected pilots, and self-published accounts of program participation have also proliferated, reflecting ongoing debate about program practices. These sources represent participant perspectives and advocacy positions rather than peer-reviewed assessments of program outcomes.

See also

• Air traffic controller
• Aviation medicine
• Aviation safety
• Random drug testing
• Alcoholics Anonymous
• Substance use disorder
• Occupational health psychology
• Aviation medical examiner
• Whistleblower protection in the United States

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79. "Barnard v. Kozarsky". Justia Dockets & Filings. Retrieved January 17, 2026.
80. "Barnard v. Kozarsky". Law360. Retrieved January 17, 2026.
81. "Air Force Veteran Says United Fired Him Over False Alcohol Claim". Flying Magazine. October 29, 2025. Retrieved January 17, 2026.
82. "Air Force Veteran Says United Fired Him Over False Alcohol Claim". AirlineGeeks. October 29, 2025. Retrieved January 17, 2026.
83. "FAA investigates 5,000 pilots suspected of hiding serious health issues". The Washington Post. August 27, 2023.
84. "FAA offers medical reconciliation process to some veterans". Aircraft Owners and Pilots Association. June 27, 2023. Retrieved January 16, 2026.
85. "38 U.S.C. § 5701 - Confidential nature of claims". Legal Information Institute. Retrieved January 16, 2026.
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Further reading

• Valone, Paul. The HIMS Nightmare (2023). Self-published account of program participation.
• "Nicodemus" (pseudonym). The HIMS Experiment Exposed (2024). Self-published critique of program practices.
• Petitt, Karlene. "Petitt v. Delta Air Lines II (2025)". Documentation of ongoing follow-up litigation (Docket: 2025-AIR-00035).

External links

Official

• Official website – Official HIMS Program website (United States)
• HIMS New Zealand – New Zealand HIMS program
• HIMS Australia – HIMS Australia Advisory Group (HAAG)

Advocacy and reform

• Pilots for HIMS Reform – Pilot advocacy organization
• FAA HIMS Program Information Center – Independent information resource with proposed AEROPath alternative model
• AeroMedical Compass – Aviation medical provider accountability, ranking, and transparency project

Personal accounts and discussion

• HIMS Nightmare – Website associated with self-published book
• Karlene Petitt – Website of pilot involved in Petitt v. Delta Air Lines
• Flight to Success – Blog by Karlene Petitt
• HIMS Victims Forum – Online discussion forum for program participants