Almost 7% of the 344 general aviation pilot fatalities in 1994 were found at postmortem to have tissue levels of alcohol at 0.04% or higher. We in the Office of Aviation Medicine are concerned that many of these fatalities may have been pilots who had known alcohol problems, but did not seek help for their problem because of the fear of losing their pilot privileges, either permanently or for a very long period of time. This is the same concern that we had several years ago regarding air carrier pilots: We frequently did not know that they were alcoholics until they had a withdrawal seizure at the controls of an aircraft.

Through an innovative and cooperative program established in the mid-70s with air carrier pilot groups and managers of air carrier companies, the Office of Aviation Medicine played a key role in the establishment of a highly effective mechanism for the identification, rehabilitation, and return-to-duty of alcoholic airmen. This program, which includes a comprehensive evaluation and monitoring system, has permitted the Federal Aviation Administration to return thousands of air carrier pilots to airman duties shortly after initiation of rehabilitation. Currently, 851 airmen who have a history of alcoholism hold First-Class medical certificates.

Most of these airmen are air carrier pilots. Without such a progressive approach to the certification of alcoholic air carrier pilots, it is likely that many of these airmen would never have been identified and could have been driven "underground" by an inflexible certification system. With our current system, however, these airman have been identified, properly treated, and returned to gainful employment without compromising the safety of the passengers that they carry or the other pilots with whom they share the skies. Now, with twenty years of experience in the certification of alcoholic commercial airmen, and in view of the excellent safety record that we have maintained, we are preparing to change the way that we certify private pilots who have a history of alcoholism. Currently, the regulations call for two years of sustained total abstinence before certification can be considered. We will now consider shortening that required minimum period to one year, under the following conditions:

• favourable psychiatric and psychological testing,
• successful completion of an inpatient or intensive outpatient program with a documented commitment to abstinence,
• participation in an acceptable aftercare program consisting of individual and group counselling sessions for at least 12 months,
• establishment of a monitoring system that includes a physician with expertise in substance abuse disorders, and
• additional monitoring reports from employers, family physicians, or others, as well as alcohol testing when indicated.