Another ADD question for Dr Bruce *sigh*

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I know a young airman, good guy, good career, has his PP and getting ready to start IR training.

He went to renew his 3rd class medical, and put in medxpress that he was taking adderall. The AME he was working with asked for his conf code, so he thinks it was submitted.

I called him to get the full story:

He had been diagnosed ADD in childhood and took adderall thru 2nd year college, then not for a number of years, and then recently started again. He never disclosed any of this on his original medical application.

What does he face? Is there a chance to get his medical? If so I may reach out to you Bruce to talk further and put him in contact with you.

Thanks.
 
Oh dear.

Add to this the confirmation that he thinks he does better with the pills, means he may not score so well on the attached batter (which is very pricey- think $2,500 and none of it insureable).

:(
Send me an email.
 

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ask to read the language on the 8500-8 where it asks 'have you ever. . . " and ask him if he thinks he has a disclosure problem . . .
 
wow, the crap that the FAA wants to put someone through for mental health is absolutely insane. DUI, substance abuse, alcoholic, or an arrest for drug possession? No problem, just show the FAA that you haven't gotten into trouble lately and your good to go. Have ADD, anxiety, or have been depressed at some point in your life? oh boy, stop the show while they crawl up your butt and pry into every aspect of your life.
 
Hey!

Your CONGRESS of the United States demanded this.
Tell congressman Mica but 900:1 sez you don't follow through. The arguments don't make a lotta sense when you them out in public. It's like trying to argue against motherhood, or, security.
 
Hey!

Your CONGRESS of the United States demanded this.
Tell congressman Mica but 900:1 sez you don't follow through. The arguments don't make a lotta sense when you them out in public. It's like trying to argue against motherhood, or, security.

Dr Bruce, I'm actually one of the few that does get involved. The reason an argument may not make sense in public is because the general public has grown to believe that "government knows best". The FAA scrutinizes a person that has had anxiety or depression in their life much more so than a person that has already proven that they have a blatant disregard for the safety of others (persons with 1 or more DUI convictions).
 
Dr Bruce, I'm actually one of the few that does get involved. The reason an argument may not make sense in public is because the general public has grown to believe that "government knows best". The FAA scrutinizes a person that has had anxiety or depression in their life much more so than a person that has already proven that they have a blatant disregard for the safety of others (persons with 1 or more DUI convictions).

I think the difference is, the drinking problem can be addressed through abstinence. If the inherent cognitive abilities are permanently impaired in ways that impact the safety of flight (which is the FAA's position on ADHD), that's a bigger issue and one that can't be addressed by abstaining from something.

What I think really sucks are the cases where it was inappropriately diagnosed as a child and he'll bear that diagnosis for life. Sounds like your friend recognized the need for help by going back on the meds. I feel bad for him, but I think he's got a tough row to hoe at this point.
 
Now I've connected two and two. See the E-mail. The problem is "SQUIRREL" (from the movie "up"). This person is successful, and competent WHEN HE HAS THE MEDS. Their view, is what happens when he forgets his med, on the day of the accident.

So he either has to have a multi year implant, dosage of which he cannot forget/control, and get a multiyear SI for operating only with that med, or he has to be able to operate without the med(s).

I believe I sent the specification sheet. Aviation is unforgiving of bad decisionmaking or failure of thorough assessment before decisionmaking. Business actually, on the other had, actually rewards the ADD thought style- two minutes on this fire, a minute on this crisis, then off to the next time. Aviation....not so much.
 
Now I've connected two and two. See the E-mail. The problem is "SQUIRREL" (from the movie "up"). This person is successful, and competent WHEN HE HAS THE MEDS. Their view, is what happens when he forgets his med, on the day of the accident.

Dr. B...

Not questioning that this is the thinking from the FAA, but the question is: How is this different from an alcoholic? How can they ensure that said alcoholic didn't fall off the wagon on the day of the accident?

So, for repeat DUIs or other evidence of alcohol dependence, they require a period of documented dry, right? Why couldn't they do the same with ADHD...a sufficient period of ensuring that the individual is on their meds. The AA program is replaced by being under the care of an appropriate physician on their program.

Please don't read this as any form of criticism of you and your phenomenal efforts on behalf of us airmen...I just see considerable parallels and was curious if those parallels could be utilized to help folks out...
 
Dr. B...

Not questioning that this is the thinking from the FAA, but the question is: How is this different from an alcoholic? How can they ensure that said alcoholic didn't fall off the wagon on the day of the accident?

So, for repeat DUIs or other evidence of alcohol dependence, they require a period of documented dry, right? Why couldn't they do the same with ADHD...a sufficient period of ensuring that the individual is on their meds. The AA program is replaced by being under the care of an appropriate physician on their program.

Please don't read this as any form of criticism of you and your phenomenal efforts on behalf of us airmen...I just see considerable parallels and was curious if those parallels could be utilized to help folks out...

Because congress is full of alcoholics and, oh look a puppy....
 
If a candidate makes it through their adolescence without having ever been put in the system, no meds, etc., they pass a basic class III with no questions asked (flying colors, one might say). OTOH, any bloke with an MD and an Rx pad can brand the kid as unairworthy for life. Furthermore, it takes more than some other bloke with a script pad to rebut the diagnosis; the FAA wants Moses and the 4-axis tablets to pronounce on the matter.

ETA: This can't possibly be why the number of pilots is relentlessly shrinking, can it?
 
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Dr. B...

Not questioning that this is the thinking from the FAA, but the question is: How is this different from an alcoholic? How can they ensure that said alcoholic didn't fall off the wagon on the day of the accident?

So, for repeat DUIs or other evidence of alcohol dependence, they require a period of documented dry, right? Why couldn't they do the same with ADHD...a sufficient period of ensuring that the individual is on their meds. The AA program is replaced by being under the care of an appropriate physician on their program.

Please don't read this as any form of criticism of you and your phenomenal efforts on behalf of us airmen...I just see considerable parallels and was curious if those parallels could be utilized to help folks out...
The parallels are actually not parallel. We don't let the alcoholic airmen go back until the brain changes associated with alcoholism have reversed. We can see 'em on a PET scan. Takes about 6-8 months.

NOTHING like that happens in ADD.
 
The parallels are actually not parallel. We don't let the alcoholic airmen go back until the brain changes associated with alcoholism have reversed. We can see 'em on a PET scan. Takes about 6-8 months.

NOTHING like that happens in ADD.

Cool...did not know that!
 
The parallels are actually not parallel. We don't let the alcoholic airmen go back until the brain changes associated with alcoholism have reversed. We can see 'em on a PET scan. Takes about 6-8 months.

NOTHING like that happens in ADD.

That is interesting. What is the tell in the scan of an active alcoholic, and what changes after 6-8 months of recovery?

I think this is cool. Besides the constant monitoring and random tests, there is a sound, scientific, method to prove recovery.
 
Wanna do a radiology residency?
Wanna look at a scan and make diagnoses?
How am I supposed to answer that question in a way that is meaningful to you?

The amygdala and uncinate uptakes in concert with the remainder of the basal ganglia complex are distinct changes in uptakes. There, did I do well?

Now would you like to know which way the uptakes change....and would you like to learn to recognize the patterns....

aw, c'mon.....gees.
 
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Wanna do a radiology residency?
I don't think I have the time or the prerequisites for that...


Wanna look at a scan and make diagnoses?
No, but I might be interested in seeing the before/after differences.


How am I supposed to answer that question in a way that is meaningful to you?
You pretty much have, Doc, and thanks!


The amygdala and uncinate uptakes in concert with the remainder of the basal ganglia complex are distinct changes in uptakes. There, did I do well?
Yup. My previous knowledge combined with a little Googling has been elucidating.

Now would you like to know which way the uptakes change....and would you like to learn to recognize the patterns....

aw, c'mon.....gees.

I know how hard it is for an expert to make it understandable to a layman. You done good.

This also seems to support the position that, at least in the case of alcohol, addiction is indeed a "disease" which some folks still dispute, preferring to think of it as a lack of willpower or a moral failing.
 
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Wanna do a radiology residency?
Wanna look at a scan and make diagnoses?
How am I supposed to answer that question in a way that is meaningful to you?

The amygdala and uncinate uptakes in concert with the remainder of the basal ganglia complex are distinct changes in uptakes. There, did I do well?

Now would you like to know which way the uptakes change....and would you like to learn to recognize the patterns....

aw, c'mon.....gees.

Made it sound pretty simple for a guy who works in the field and looks at CT's. MRI's and PET scans and has little clue of what he's looking at besides the CT scans.... and even then its only a slightly less little clue.
 
This also seems to support the position that, at least in the case of alcohol, addiction is indeed a "disease" which some folks still dispute, preferring to think of it as a lack of willpower or a moral failing.

Wouldn't it be more accurately considered a susceptibility to addiction? If one actually has a disease they need treatment. Without the addition of alcohol, one with the predisposition requires none.

If it only were so easy to avoid the myriad of other diseases that plague us.
 
OP: The pilot in question should have just kept his mouth shut. They would have never found out. If he flied commercially they would drug test and assuming he he was prescribed adderall/vyvanse etc. and takes it daily it would likely come up positive for amphetamines. In that case he would have been in some hot water. As a private pilot he could have kept taking the prescription and would have been fine.

Now that he admitted to it the odds of him keeping his license are slim to none. Will the faa fine him or throw him jail? Unlikely. He will probably just lose his license and that will be the end of it. It's all empty threats the FAA almost never does anything from a criminal stand point and rarely issues fines for matters such as these. The lesson to be learned here is keep your mouth shut on these type of issues and you will be fine.
 
OP: The pilot in question should have just kept his mouth shut. They would have never found out. If he flied commercially they would drug test and assuming he he was prescribed adderall/vyvanse etc. and takes it daily it would likely come up positive for amphetamines. In that case he would have been in some hot water. As a private pilot he could have kept taking the prescription and would have been fine.

Now that he admitted to it the odds of him keeping his license are slim to none. Will the faa fine him or throw him jail? Unlikely. He will probably just lose his license and that will be the end of it. It's all empty threats the FAA almost never does anything from a criminal stand point and rarely issues fines for matters such as these. The lesson to be learned here is keep your mouth shut on these type of issues and you will be fine.
What LOUSY advice from a CFI?(!). We gave up all privacy in the Healthcare Act of 2012. The prescriptions will be found by any GS1 or 2 doing the routine investigation after any incident, deal or whatever, and that will cause action against the PILOT certificate.

If you are a CFI you need to be eradicated from the CFI pool

CFI.
 
Wouldn't it be more accurately considered a susceptibility to addiction? If one actually has a disease they need treatment. Without the addition of alcohol, one with the predisposition requires none.

If it only were so easy to avoid the myriad of other diseases that plague us.

Actually, in my experience, a person with an alcohol addiction and the brain anomolies described by Doc Bruce, has behavioral problems whether they are actively drinking or not. Avoidance of alcohol may be required for recovery, but is not sufficient.
 
Actually, in my experience, a person with an alcohol addiction and the brain anomolies described by Doc Bruce, has behavioral problems whether they are actively drinking or not. Avoidance of alcohol may be required for recovery, but is not sufficient.

But then I'd find another term for that condition since, by definition, "alcoholism" requires alcohol.
 
Chien what healthcare act are you talking about? I didn't know there was an act in 2012. Do you mean the affordable care act of 2010? Can you explain which you act you are talking about? If that moron Obama passed another act besids the affordable care act I definitely want to know about it.
 
Dr. Chien could you also give a link or something to what you are talking about with giving away diagnostic codes? I am livid about this. I'm in the middle of writing up a letter to my congresswoman Ann Wagner right now and I want to give her a link or something so she know whats I am talking about. Odds are our representative and senators don't read most of the bills they vote for. If this is going on and the representatives and senators of my state voted for it or didn't do enough to stop it they are going to hear about it.
 
Mark, you're right. 2010. I don't know why I was thinking 2012.....

Bruce, do you know where it is in the act that says diagnosis codes are not part of the medical record or whatever? I am planning on writing my congresswoman here in Saint Louis and my state senators this week if I get some free time.
 
Mark, I'm on the road on VACA and I sure don't carry the Federal Register with me....
 
Now I've connected two and two. See the E-mail. The problem is "SQUIRREL" (from the movie "up"). This person is successful, and competent WHEN HE HAS THE MEDS. Their view, is what happens when he forgets his med, on the day of the accident.

So he either has to have a multi year implant, dosage of which he cannot forget/control, and get a multiyear SI for operating only with that med, or he has to be able to operate without the med(s).

Dr. Bruce - apologies for resurrecting such an old thread, but I’ve been doing a lot of research on this recently, and you hit on what seems to be the crux of the issue for me (an aspiring pilot who takes ADHD meds)—the FAA’s refusal to permit pilots to use the ADHD meds.

As I see it, the current system actually incentivizes unsafe behavior: pilots who recognize that they would benefit from ADHD medication will not get treatment in order to avoid problems with their medical. Sure, they’re competent enough to fly without the meds, but they’d be better (and, assuming no adverse reactions to the pills), safer pilots with it.

If the FAA requires a pilot to demonstrate X amount of focus/concentration to get a medical, and the pilot without medication functions at X+10, but with mediation would be X+40, it seems like the current system incentivizes people to be less safe than they could be.

I 100% understand the concern with people forgetting their medication. I’ve done it (no more than a couple days a year, but it does happen, usually when something throws off my morning routine). People who cannot demonstrate a minimum required amount of focus without medication (the “SQUIRREL” people) have no business flying planes. If they forget to take their pill and then go flying, bad things could happen.

But what about people in the middle? Like you said, the FAA only requires that pilots score better than the bottom 15%. That leaves a huge crop of people who CAN demonstrate sufficient focus without medication, but who would nonetheless derive substantial benefit from medication, both in the cockpit and in other areas of life. The current system forces such people to choose between the very real benefits of medication and being able to fly.

Wouldn’t a more rational setup be something like the following?

1. If you’re currently prescribed ADHD medication, the FAA will need to see medical history demonstrating that you’re stable and don’t exhibit any dangerous side effects.

2. To prove that you’d be safe even if you forgot to take your pill, the FAA can require you to stop medication for a period (however long is necessary to flush the drugs from your system—I believe the current standard is 90 days). Then you’ll have to pass the battery of neuropsych tests, take the drug test, etc.

Once you’ve proven that you’re safe enough even without the meds, and that you’re unlikely to suffer any problematic side effects, you should be good to go even if you’re actively taking the drugs, right? Maybe throw in some follow-up periodic certifications from your prescribing doctor for good measure to ensure no side effects have developed. Federal law requires that prescribers of ADHD meds meet with their patients at least every 90 days before writing a new script, so there will be plenty of ongoing medical contact.

That would seem to uphold current safety standards while also addressing an increasingly prevalent medical diagnosis. And it prevents a growing number of pilots and would-be pilots from having to choose between being able to fly and living up to their full potential outside the cockpit.

Curious for your thoughts.
 
Dr. Bruce - apologies for resurrecting such an old thread, but I’ve been doing a lot of research on this recently, and you hit on what seems to be the crux of the issue for me (an aspiring pilot who takes ADHD meds)—the FAA’s refusal to permit pilots to use the ADHD meds.

As I see it, the current system actually incentivizes unsafe behavior: pilots who recognize that they would benefit from ADHD medication will not get treatment in order to avoid problems with their medical. Sure, they’re competent enough to fly without the meds, but they’d be better (and, assuming no adverse reactions to the pills), safer pilots with it.

If the FAA requires a pilot to demonstrate X amount of focus/concentration to get a medical, and the pilot without medication functions at X+10, but with mediation would be X+40, it seems like the current system incentivizes people to be less safe than they could be.

I 100% understand the concern with people forgetting their medication. I’ve done it (no more than a couple days a year, but it does happen, usually when something throws off my morning routine). People who cannot demonstrate a minimum required amount of focus without medication (the “SQUIRREL” people) have no business flying planes. If they forget to take their pill and then go flying, bad things could happen.

But what about people in the middle? Like you said, the FAA only requires that pilots score better than the bottom 15%. That leaves a huge crop of people who CAN demonstrate sufficient focus without medication, but who would nonetheless derive substantial benefit from medication, both in the cockpit and in other areas of life. The current system forces such people to choose between the very real benefits of medication and being able to fly.

Wouldn’t a more rational setup be something like the following?

1. If you’re currently prescribed ADHD medication, the FAA will need to see medical history demonstrating that you’re stable and don’t exhibit any dangerous side effects.

2. To prove that you’d be safe even if you forgot to take your pill, the FAA can require you to stop medication for a period (however long is necessary to flush the drugs from your system—I believe the current standard is 90 days). Then you’ll have to pass the battery of neuropsych tests, take the drug test, etc.

Once you’ve proven that you’re safe enough even without the meds, and that you’re unlikely to suffer any problematic side effects, you should be good to go even if you’re actively taking the drugs, right? Maybe throw in some follow-up periodic certifications from your prescribing doctor for good measure to ensure no side effects have developed. Federal law requires that prescribers of ADHD meds meet with their patients at least every 90 days before writing a new script, so there will be plenty of ongoing medical contact.

That would seem to uphold current safety standards while also addressing an increasingly prevalent medical diagnosis. And it prevents a growing number of pilots and would-be pilots from having to choose between being able to fly and living up to their full potential outside the cockpit.

Curious for your thoughts.

This article goes over many of your points

https://scholar.smu.edu/cgi/viewcon...e.com/&httpsredir=1&article=1317&context=jalc
 
Hey. Federal policy is, what it is. It took me six years to get the to adopt an SSRI pathway. Having seen the soectrum, pesonally I think FAA has to have a SERIOUS evaluation and be objective about this.

A pilot with amphetamines in his pee is on serious career trouble...and would be lucky if his career doesn’t end there and then....and Adderall is the same stuff in pee.....

“Banging at the gate” does not help....
 
It seems to me a big part of being a pilot is realizing when it is not safe to fly and refusing to fly. I worry about pilots rationalizing unsafe conditions so that they can justify flying, they do not make good pilots.
 
ok, I know the start of this was an old thread...but to piggy pack sort of on topic...
my son is a young teen, and we are waiting for an appointment for add evaluation. It's mild if he has it, but ....
So when I take him for his appointment are there any meds I should steer the doc away from if she's heading that route? Any better than others in the eyes of FAA?
Any other tips on how I might steer things.
He has so far shown no signs of interest in aviation, but I of course want to keep his options as open as possible.
 
ok, I know the start of this was an old thread...but to piggy pack sort of on topic...
my son is a young teen, and we are waiting for an appointment for add evaluation. It's mild if he has it, but ....
So when I take him for his appointment are there any meds I should steer the doc away from if she's heading that route? Any better than others in the eyes of FAA?
Any other tips on how I might steer things.
He has so far shown no signs of interest in aviation, but I of course want to keep his options as open as possible.

I would strongly evaluate ANY ‘ADHD’ evaluation. Over the years I’ve seen Mom, Doc, & teacher get together & gin up a pill program that I find hard to believe is needed. We’ve raised two boys, was raised with two other boys, & been around things a fair amount. I remember a teacher telling my Mom back in the 70’s that I was a ‘daydreamer’. I bet that Nun would of liked to pill me up. Without a dream or two, how is one supposed to get anywhere?

I guess I don’t know chit about medical. Take your boy on a 5 mile hike, when you get back see if he has ‘to much energy’.
 
Hey. Federal policy is, what it is. It took me six years to get the to adopt an SSRI pathway. Having seen the soectrum, pesonally I think FAA has to have a SERIOUS evaluation and be objective about this.

A pilot with amphetamines in his pee is on serious career trouble...and would be lucky if his career doesn’t end there and then....and Adderall is the same stuff in pee.....

“Banging at the gate” does not help....
Unless they are military pilots. Amphetamines in the pee is just a consequence of getting the job done. But you know those long range bombers and fighters are way easier to fly and require less skill that a single engine piston. We really NEED aeromedical to keep us safe.
 
Sourdough44, I've felt a similar way for a long time with this....the "that's just part of being a boy thing"... and have resisted DW quite a few years. In his case though...just to keep it on the correct path.... you're confusing things adding the H for hyper activity.
I'm still struggling with the concept personally, but I'm coming around to the idea that IF he does indeed have something that can help reduce problems and friction in general life, then there might be a good trade-off in there someplace. I'm thinking that IF he even does have "IT", it's mild and maybe there's something that can be done to help that causes no harm at the same time....
 
ok, I know the start of this was an old thread...but to piggy pack sort of on topic...
my son is a young teen, and we are waiting for an appointment for add evaluation. It's mild if he has it, but ....
So when I take him for his appointment are there any meds I should steer the doc away from if she's heading that route? Any better than others in the eyes of FAA?
Any other tips on how I might steer things.
He has so far shown no signs of interest in aviation, but I of course want to keep his options as open as possible.
I'm no expert on this stuff, but I believe Dr. Bruce @bbchien has said in the past that your everyday gp should not be putting kids on add meds that he should be evaluated by an expert. I'll add that in my opinion, were it my kid, it would not be someone affiliated with the school system either. Hopefully Dr B will chime in on this. If I'm mistaken I'll pull this post down.
 
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