2nd Class Medical, 2nd Deferment - Alcohol Related

C

Canception

Guest
I applied for my class 2 certification about 4-5 months ago and was deferred for asthma, depression diagnosis stemming from teenage years (haven't taken medication in 5 years), and a Marijuana offense from 6 years ago in my previous state. I sent in the paperwork that was asked and in my medical records, my previous physician mentioned depression dependence in regard to alcohol.

At the time, I was a 19/20 year old kid in a rough patch in my life and not making the best choices for my well being. I went into said clinic to ask for help as I was in an anxious state and concerned with withdrawl, which came with two follow up visits. I never received medication for the "dependence", only that my doctor recommended AA. That's the only official record I have of this notation. No hospitalization or court-orders. The administration's latest letter asks for patterns of past and current use, adverse consequences, abstinence date, quality of care, and 3 letters from respectable people in my community confirming my abstinence.

I also was asked to take a 10-panel urine test, which I passed easily.

While I don't want to send unsolicited information, I do plan to send the 8 pages of clinical records that mention this issue and a personal statement. The dilemma I'm having is that I cannot provide these letters of abstinence, as I still drink casually from time to time. I plan to mention this in the statement they're asking for. My question is: should I not send anything regarding these "3 letters of abstinence" and wait to hear back, or would letters of character suffice instead? All my reference letters come from respected medical professionals and physicians as I currently work emergent and non-emergent surgery in an OR.

I understand that ultimately it is the administration's decision, but I don't feel I'm dependent in my adult life and even my personal physician agrees, though, he suggested I should keep my statement brief and to the point and not give anything beyond what is solicited, medically speaking. I'm at a crossroad between delivering only what I can offer and seeing what comes, or sending unsolicited letters of character, rather than abstinence, in an attempt to reinforce the present.
 
The FAA stated what to submit as a condition of continued consideration of your application. If you fail to submit everything asked for, the FAA will deny.

Now, before you lie or ask someone else to lie for you, those letters are part of your application and fall under falsifying a federal document.
 
I mean how does your doctor even know about your behavior outside of the appointment?
 
bbchien said:
Guy, the FAA will find the marijuana offense.....that sort of omission is a class 4 felony. Give it up.
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I don't see any hint of an omission. I read it as the FAA already having that information.
 
My sense is the FAA is implying you need to be abstinent to get the certificate.
I recommend seeing a HIMS AME for a consult who can discuss the details with you and perhaps inquire with the FAA for clarification.
 
Canception said:
The dilemma I'm having is that I cannot provide these letters of abstinence, as I still drink casually from time to time. I don't feel I'm dependent in my adult life and even my personal physician agrees
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The first thing you must understand before you can go any further is the conflict between general medicine (clinical) vs aviation medicine (legal). The AME and the feds aren't examining you to diagnose you. It is a forensic examination to determine if your medical history and current medical state meet the FAA medical standards set forth in 14 CFR 67. You will find many conflicts between the two.

14 CFR 67.307 - Mental
Mental standards for a third-class airman medical certificate are:
(a) No established medical history or clinical diagnosis of any of the following:
(4) Substance dependence, except where there is established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years.

Here are the 4 criteria that the FAA uses as their metric to determine dependency, taken straight from 14 CFR 67.307(a)(4)(ii)...and you need only exhibit 1 of the 4 -
(A) Increased tolerance;
(B) Manifestation of withdrawal symptoms;
(C) Impaired control of use; or
(D) Continued use despite damage to physical health or impairment of social, personal, or occupational functioning.

You would definitely meet the (D) requirement, which would place you as "dependent" in the eyes of the feds.

You can "feel" you're not dependent in your adult life, and your physician may even agree. But you have a history of it, and your unwillingness to stop drinking only corroborates your current dependency in the eyes of the FAA (if you disagree, let's see you prove otherwise). Furthermore, the FAA is not asking for a "clinical" (DSM) diagnosis of "dependence", as no such diagnosis exists in general medicine. This is aviation medicine, where they are determining whether or not you meet the regulatory standard of "dependence" as published in 14 CFR 67.307(a)(4), and it is FAR different from a DSM diagnosis.

"Those who continue to insist they don't have a problem are considered to be in "denial". And the wonderful thing about denial is that you can never prove it doesn't exist." - The HIMS Nightmare: A Pilot's Guide to Surviving Substance Abuse Re-Education

You need to make the decision to stop ALL alcohol consumption if you plan to proceed forward. If you're not ready to make that committment, any further action will just be a waste of time and money. If they're asking for letters of abstinence, they will accept nothing less than abstinence from alcohol and/or mind/mood altering substances before your eligibility for even a special issuance will be considered. Furthermore, plan on at least a 2 year regimen of random substance testing, no less than 14 tests in a 12 month period, 10-panel with EtG monitoring program sponsored by a HIMS AME, and all tests bearing a result of negative BEFORE you will be considered for issuance.

If you do get issued a special issuance, you will be placed in the HIMS program and will continue to test, among other things like peer support group activities (such as AA, Birds of a Feather, etc with a sponsor), routine 3 month follow up visits with your HIMS AME, and group aftercare counseling.

The good news is that there is an off ramp. Once you're issued, comply with the special issuance authorization until the medical certificate times out, DO NOT apply to renew the certificate, then go BasicMed.
 
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Since you’ve already been deferred send in what you think will be best for your case. If it’s not sufficient they will come back and tell you what’s required of you. I hope that if you’re truly not alcohol dependent that the medical will be issued without having to go the HIMS route.
 
George S said:
Since you’ve already been deferred send in what you think will be best for your case. If it’s not sufficient they will come back and tell you what’s required of you. I hope that if you’re truly not alcohol dependent that the medical will be issued without having to go the HIMS route.
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His history of dependence, along with "Continued use despite damaging consequences" (i.e. the previous dependence diagnosis he got from his physician) ropes him into the dependence category. Along with his prior depression diagnosis, HIMS is more than likely his only option.
 
Unsolicited character references sent to the FAA won't be helpful. One way or anther you'll need a current assessment from a board certified psychiatrists that comprehensively addresses your mental health history and substance use. Unless your alcohol use disorder is roundly refuted in that evaluation, the likelihood is that you'll need to apply for your medical using the HIMS process which including alcohol abstinence and monitored recovery.
 
One of the hallmarks of dependence is "I don't feel dependent". The substance changes your perception of the relationship betwee you and the substance. That's why you're going to end up before a HIMS psychiatrist, a credible assessment.

All of the ones I use (18 of them) are much more productive if preceded by six month of privvate urine test proven abstinence. In the words of one of them, "when they are not provably sober there is a lot going on through which I have to sift" and so the chance of getting an inderterminate assessment goes way up. That is NOT what you are seeking.
 
That’s insane how someone without a substance abuse problem can go in to see a HIMS psychiatrist, tell them they do not have a problem and that psychiatrist uses that phrase to suggest they do in fact have a substance abuse problem. That BS line of questioning then goes into a report to suggest that the person suffers from denial. What a joke.
 
Half Fast said:
Bruce, I'm sure that's true, but wouldn't not feeling dependent also be a hallmark of not being dependent? If so, what good is it as a hallmark of anything?
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I won’t speak for Bruce, but trusting the judgement of someone who has a track record of bad decisions on the topic is hard to do.

Were someone to ask me to prove I’m not dependent, I simply ask the how would they like that proof?

Then I’d give them exactly what they asked for.
 
To clarify…

The FAA does not practice AMA medicine.
They do not practice clinical medicine.
They do not practice forensic medicine.

They practice SELECTIVE ADMINISTRATIVE medicine.

Why selective? They WILL use their administrative definition of “dependence”. They WILL NOT use their codified LAW of 2 yrs proven abstinence to issue an unrestricted medical, favoring internal unpublished POLICY.

Find an FAA administrative medicine genius, Chien is one, there are others, THAT YOU LIKE, press forward.
 
George S said:
That’s insane how someone without a substance abuse problem can go in to see a HIMS psychiatrist, tell them they do not have a problem and that psychiatrist uses that phrase to suggest they do in fact have a substance abuse problem. That BS line of questioning then goes into a report to suggest that the person suffers from denial. What a joke.
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uh, I think you are mischaracterizing it. He went in to his own clinic (nothing to do with the FAA) and notes on dependence were made by that doctor. Not HIMS, not an AME. The current AME is dealing with a known drug offense, and clinical notes of dependency. So not sure where you are getting a HIMS psych is doing this.
 
Tools said:
To clarify…

The FAA does not practice AMA medicine.
They do not practice clinical medicine.
They do not practice forensic medicine.

They practice SELECTIVE ADMINISTRATIVE medicine.

Why selective? They WILL use their administrative definition of “dependence”. They WILL NOT use their codified LAW of 2 yrs proven abstinence to issue an unrestricted medical, favoring internal unpublished POLICY.

Find an FAA administrative medicine genius, Chien is one, there are others, THAT YOU LIKE, press forward.
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I think most people would consider "medical practice" to be the application of drugs, surgical procedures, therapies, lifestyle recommendations, etc., for the purpose of preventing or curing diseases, physical injuries, and abnormalities. Simply stated, medical practitioners seek to use their skills to improve the health of patients.

In that sense, FAA Aeromed does not practice medicine at all. They do not seek to treat or cure anyone and are not concerned with improving health. Their task is merely to assess whether a pilot's health is such that there is a low risk of incapacitation or inability to fly an aircraft safely. That assessment is done to standards of the FAA's own choosing and not necessarily to a consensus standard of the medical community, and in some cases those FAA "standards" are unpublished capricious opinions.

That's why it's necessary to have someone who is an expert in OKC-speak, like Bruce or Lou, to lead a pilot through the minefield.

If the OKC physicians were brain surgeons they'd be out practicing brain surgery, rather than working as government bureaucrats who do not really practice medicine at all.
 
George S said:
That’s insane how someone without a substance abuse problem can go in to see a HIMS psychiatrist, tell them they do not have a problem and that psychiatrist uses that phrase to suggest they do in fact have a substance abuse problem. That BS line of questioning then goes into a report to suggest that the person suffers from denial. What a joke.
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The enlightened answer is, "I might have a problem. How do I go about substantiating my situation"
Substance is super sneaky. It changes your perception of what your situation is.
Now compare that to "I don't think I'm dependent."

(Notice I never once asked the OP to define dependent. I'll bet he can't. I'll bet the "personal physician" who is represented as in agreement, can't give the part 67 definition) And if "that doctor" the one from long ago, recommended "AA", whaddaya think that guy thought?
 
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Half Fast said:
Bruce, I'm sure that's true, but wouldn't not feeling dependent also be a hallmark of not being dependent? If so, what good is it as a hallmark of anything?
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It's not a hallmark, it's the opposite. A hallmark is a distinguishing characteristic, so if not feeling dependent was a hallmark of dependence, it would mean that you couldn't feel not dependent if you actually weren't dependent. That's self-evidently not the case. What it's actually is circular reasoning: Once it's been determined that you're dependent, if you deny dependence it's confirmation that the initial determination is correct. Of course if you admit dependence, it's also confirmation that the initial determination is correct.
 
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That's acutally correct, & thank you :) (Half Fast, and Lindberg).

NB when you do what I do, you get really good at reading personal statements. The OP sez the first doc "recommmended AA" which is what a community doc does when in DSM 4 or DSM 5 you think the guy is DSM alcohol dependent. E.G no awareness of how alcohol changes his judgement.

Had he said: "I might have a problem. How do I go about substantiating my situation?" that would reflect awarness of the prior paragraph. But he did not. Alcohol is indeed a "cunning enemy" as Dr Robert Smith wrote in 1935 as it changes ones' perceprtion as to his situation. That changed perception is part of dependency and the individual would not be aware of such.

The FAA does care about the present but the OP does not realize that the FAA consideres the ENTIRE LIFE, not just the DSM5 "last 2 years"
So it is much more probable (not CERTAIN) that the OP is blithely unaware that by part 67 definitions he'll be found dependent. And the OP also doesn't know (and this is to tell him) if he is found dependent with any-in-the-life recurrence of depression, he is a "dual diagnosis" applicant and the agency would then not consider any certification until he had experienced rehab: that' what Hank William wrote about in "I saw the light".

Frequently when I engage a new person trapped in the web, the first thing he says is sooo incredibly revealing. And the subsequent evaluations bear that out (not always, but better than 3/4 of the time).


B
 
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Lindberg said:
It's not a hallmark, it's the opposite. A hallmark is a distinguishing characteristic, so if not getting dependent was a hallmark if dependence, it would mean that you could feel not dependent if you actually weren't dependent. That's self-evidently not the case. What it's actually is circular reasoning: Once it's been determined that you're dependent, if you deny dependence it's confirmation that the initial determination is correct. Of course if you admit dependence, it's also confirmation that the initial determination is correct.
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That makes a lot more sense.
 
One of the primary hallmarks of addiction (any type….be it drug/alcohol, gambling, shopping) is denial of the disease in the face of substantial evidence to the contrary. If you have ever participated/guided an intervention, and I have, you would see how powerful and well documented that denial can be. In one particular case I presented overwhelming evidence of a particular drug addiction to the afflicted, along with another professional colleague, and he staunchly denied any issues and refused treatment in spite of knowing that we had to inform the state board of our concerns if he didn’t cooperate with a 3 day evaluation. He was found dead of an overdose in his office by his father a couple of months later….the same father who resented me and my colleague for attempting to keep the licensing board out of the picture. I can give several more heartbreaking examples. I understand the FAA’s position of being overly cautious and making applicants jump through many hoops to help eliminate potential untreated substance abusers from getting in the cockpit. Unfortunately many truly innocent applicants/pilots get caught in this bureaucracy and costs them time, money and possibly a career. I’m not in any way agree with the FAA’s administrative actions….the system certainly has great deficiencies….but I understand the rationale behind their policies in regards to HIMS addiction cases.
 
Lindberg said:
That last part is key, but often gets elided or replaced by, "my thinking you have a problem."
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Very true. However, probably more often correct in assuming so based upon common experience. Unfortunately their erring on the side of safety throws some babies out with the bath water. Hopefully one day this cluster gets fixed.
 
A person who doesn't have a drinking problem might say that they don't.
A person who does have a drinking problem might say that they don't.

Sounds like the statement has no diagnostic value.
 
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Palmpilot said:
A person who doesn't have a drinking problem might say that they don't.
A person who does have a drinking problem might say that they don't.

Sounds like the statement has no diagnostic value.
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Correct. If there is anything in the background/past that suggests it may be a possibility it seems like the default is to assume the worst until proven otherwise. I understand why they would rather deny ten legitimate cases while blocking the one bad actor. Sure sucks and there has to be a better way but no motivation for the FAA to change it seems.
 
Palmpilot said:
A person who doesn't have a drinking problem might say that they don't.
A person who does have a drinking problem might say that they don't.

Sounds like the statement has no diagnostic value.
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Even more so an issue...they try to equate "substantial evidence to the contrary" as just one or two DUI's from more than 15 years back.

While DUI is a serious offense, and I don't condone it in any way, shape, nor form, those with a genuine problem will have a bit more damaging consequences than just two DUI's as "substantial evidence to the contrary".

They say "Oh we're not punishing you. We just have to make sure you're getting the proper care." But when it's two DUIs, 5 years apart, the most recent one was 15 years ago, and they're sentencing you to a laundry list of highly expensive requirements as if you just got both DUIs a week ago, they're punishing you.
 
I’m not going to debate punishment or not - but the reality is that someone who has two DUIs was only caught twice. Almost certainly happened many more times but wasn’t caught…..
 
Anthem said:
I’m not going to debate punishment or not - but the reality is that someone who has two DUIs was only caught twice. Almost certainly happened many more times but wasn’t caught…..
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Statistically, this is correct. Not everyone fits the statistic but the FAA appears to be playing the odds. Sucks to be that guy, I know.
 
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