Alcohol Clarification Question

[bussy77]

About 6 months ago I went to my doctor because I was having alcohol withdrawal symptoms and was looking to help reduce them. I was going through a rough month prior and was drinking heavily pretty much every night. On my medical diagnoses he included F10.10 ETOH abuse. I didn't know how to answer question 18.o and was hoping for your thoughts.

-Thanks

 

[Ravioli]

I suppose if you want to get a medical you could try lying.

Good luck.

[Note - probable troll, no need to invoke the polite talk to Dr. ____ that is usually done]

 

[RyanB]

I suppose if you want to get a medical you could try lying.

Good luck.

[Note - probable troll, no need to invoke the polite talk to Dr. ____ that is usually done]

No doubt. That line is waay overused.

 

[AggieMike88]

I didn't know how to answer question 18.o and was hoping for your thoughts.

Based on the information you have provided, 18o. is a definite yes.

As to whether you can hold a FAA medical certificate, you should consult a Senior level, difficult case, HIMS AME.

There will be many items to obtain, and some will be expensive.

 

[bussy77]

Sorry I forgot to mention that I'm currently a student starting to get his license and was looking to get my class 3, I'm pretty sure that changes nothing, but just wanted to check. AggieMike88, when you say expensive, do you have a rough estimate of what that may be $100 - $500, $500 - $1000, $1000+? If I were to go to consult a HIMS AME like you suggest would that be a one time thing if approved? Thanks for any more info, I really do appreciate it since I'm just getting started in flying, sounds like it might be short lived unfortunately.

 

[skier]

Go Sport pilot.

 

[bussy77]

Wouldn't that require a medical as well?

 

[bussy77]

Oh and something I left out, after the diagnoses there was no treatment, just some medication to help.

 

[Rushie]

Oh and something I left out, after the diagnoses there was no treatment, just some medication to help.

If the medication is klonopin (clonazepam) that too is a deal killer, I'd advise you to taper off it forthwith. I'm not an AME but if you have no DUI or any other arrests involving substances, that improves the picture. But I agree with Mike. Consult a senior HIMS AME before you apply for a medical. Do not apply for a medical unless you know the outcome. A denial will lock you out of Sport Pilot. And yes I think you're looking at spending over a thousand and this will require total abstinence.

Edit: And the answer is yes. As the first response said you can try "no" and see what happens if/when the FAA catches the lie.

 

[AggieMike88]

Sorry I forgot to mention that I'm currently a student starting to get his license and was looking to get my class 3, I'm pretty sure that changes nothing, but just wanted to check. AggieMike88, when you say expensive, do you have a rough estimate of what that may be $100 - $500, $500 - $1000, $1000+? If I were to go to consult a HIMS AME like you suggest would that be a one time thing if approved? Thanks for any more info, I really do appreciate it since I'm just getting started in flying, sounds like it might be short lived unfortunately.

First off, in no way am I any sort of expert of how your case is to progress. All I am is a regular "joe pilot who is a member of this forum" who is willing to share with you what I have learned by paying attention to these forums and knowing how to use the search feature. If you want to play within the FAA's sandbox, you will need to find the right FAA's HIMS(Human Intervention Motivation Study) Aviation Medical Examiner to manage you case from beginning to end.

I don't have a clear figure on cost. But we have been told all testing for this will be out of pocket. Budgeting at least $5,000-$8,000 might be what is needed to get you your special issuance medical. There have been mentions of the requirement to see a HIMS phsychiatrist and a neuro psychologist, and both are about $3,500 each.

And it takes considerable time, considerable dedication, and a requirement to become completely sober . . . . Forever. One drink... just one, will eff up your progress and either reset back completely to zero, or wash you out of the entire program. And any money spent on the tests, doctors, and rehab activities will be gone... forever... over a single drink of alcohol.

So you must be ready for a very long and difficult slog to the sober finish line

Something else you have not touched on but the FAA is gonna want to know is if there have been any law enforcement actions while you were intoxicated. If there were, then there will be lots of documentation requirements about these. And these will be used to establish any applicable patterns of use and or abuse.


Dr. Bruce Chien is one of our experts on challenging medical certificate applications. And he has weighed in many times on how the FAA thinks about alcohol, especially dependence. After searching for past threads on applying for a medical with a alcohol dependency history (btw, you can and should do this too), I have copied some of his posts that might have the most value. His words are in purple-blue color. He also will have better guidance on costs and time required.

Most here don't understand alcohol dependence. Alcohol dependence can continue after many many years of abstinence. It's not about what's in your mouth, that's "abuse". Yes you have to be abstinent to be in recovery. It's about what's between your ears, not so much what's in your mouth! A person in recovery realizes he cannot drink. It'll win and he'll do something adverse. Like Joe (comanchepilot) sez, FAA really wants you abstinent after any alcohol event. You want to also, because the second event is the definition of abuse, and it doesn't have to be DUI- it can be wet reckless, domestic disputes, GF call into the hotline. I hate to sound like GWB: but just don't do that s_it. Continue even occasional drinking simply displays lack of insight.

The agency has 5 criteria and any one, EVER in your life gives the dx of dependence (and these also display lack of insight):

Tolerance
Any withdrawal syndrome
Lifestyle centered on the use of the substance
Repeat use in the face of know adverse outcomes.
Preoccupation with use.

And they're not interested in just the last 2 years per DSM 5. They want to know "ever in your life". FAA has no use for "Alcohol Use Disorder Mild-Mod-Severe". They want YES/NO.

For revenue grade certificates, Treatment is mandated = rehab --->instruction as to insight.
For third class certificates, the opinion of a HIMS Psychiatrist, adequate recovery activities (which show insight), concurred by a HIMS AME, after 24 months of proven abstinence, is sufficient.
_________________________________________

Pilot 91, the gallery here did a very good job on the string. You ARE one of them (Dr. Chien is referencing an alcohol dependent person. -AM88), it would appear.

You have two choices: 2 years of demonstrated sobriety and adequate recovery activities: = Logged AA attendance-->commitment to the notion that although you can go long periods without a drink, you ARE alcohol dependent. "WHAT!" you say, "hell no!". "I am not dependent" which is what you don't get. Sobriety is one thing- that's about what's in your mouth. Recovery is about what's in between your ears. Continuing to drink AT ALL, is in the eyes of the FAA, "he does not get it".

Well, yes you are dependent. You meet FAA's definition. 0.20 means you have been drinking long and hard over time but were still able to be "functional". that means, tolerance and you have it. Tolerance is one of the FAA five criteria. Sorry, you have it and the skies belong to the crown.

After 2 years proven sobriety if you can get a HIMS psychiatrist to agree, you will have satisfied 67.307 (read the definition of abuse) and will have proven you are in compliance with 67.307, and not before.

Then you can get a 3rd class and you have three further years of monitoring ahead of you. But get it in your head that you have a lifestyle cented on the use of alcohol (another FAA criteria), even with long gaps .
***

If you want a revenue grade medical, you need formal rehab. "WHAT!" you say, "hell no!". We're talking 4 weeks, 8 hr/day, intense, no phone, FAA wants inpatient if you can get it. And on it goes.
​

There maybe much more you need to know. And that is where the FAA HIMS AME can provide the guidance. And perhaps Dr. Bruce will see this thread and add additional comment.

​

 

[bussy77]

It was Chlordiazepoxide, which I only took for the few days after the symptoms started (6 months ago.) And you're correct, no DUI or other substances. Just a rough patch in life I decided to drown out.

 

[bussy77]

Thank you very much again Aggie, judging by his previous responses it seems very cut and dry. I would love to hear his insight to this specific issue, but I'm guessing the options are either expensive testing, evaluations, and complete abstinence or no certificate. If anyone else has anything to add, it would be greatly appreciated.

 

[AggieMike88]

The mention of FAR §67.307 had me go look to see what it had to say.

I am copying it here for your reference. And paragraph (a)(4) is where the language applicable to your situation begins.


§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:

(1) A personality disorder that is severe enough to have repeatedly manifested itself by overt acts.

(2) A psychosis. As used in this section, “psychosis” refers to a mental disorder in which—​

(i) The individual has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition; or

(ii) The individual may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition.​

(3) A bipolar disorder.​

(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. As used in this section—​

(i) “Substance” includes: alcohol; other sedatives and hypnotics; anxiolytics; opioids; central nervous system stimulants such as cocaine, amphetamines, and similarly acting sympathomimetics; hallucinogens; phencyclidine or similarly acting arylcyclohexylamines; cannabis; inhalants; and other psychoactive drugs and chemicals; and​

(ii) “Substance dependence” means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine-containing (e.g., caffeine) beverages, as evidenced by—​

(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.​

(b) No substance abuse within the preceding 2 years defined as:

(1) Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous;​

(2) A verified positive drug test result, an alcohol test result of 0.04 or greater alcohol concentration, or a refusal to submit to a drug or alcohol test required by the U.S. Department of Transportation or an agency of the U.S. Department of Transportation; or​

(3) Misuse of a substance that the Federal Air Surgeon, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds—​

(i) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or​

(ii) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.​

(c) No other personality disorder, neurosis, or other mental condition that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or​

(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.​

[Docket No. 27940, 61 FR 11256, March 19, 1996; as amended by Amdt. 67–19, 71 FR 35764, June 21, 2006]

 

[AggieMike88]

Thank you very much again Aggie, judging by his previous responses it seems very cut and dry. I would love to hear his insight to this specific issue, but I'm guessing the options are either expensive testing, evaluations, and complete abstinence or no certificate. If anyone else has anything to add, it would be greatly appreciated.

Out of curiosity, do you feel you are cabable of complete abstinence and want 100% sobriety? This journey needs to start with that single step of you wanting to make that change and begin a life of accountability (that might include documented counseling and daily attendance of meeting and finding a sponsor to keep you accountable).

Then if you can hold it together and be 100% sober for 24 months, flying becomes the massive reward in addition to your changed life.

 

[AggieMike88]

On my medical diagnoses he included F10.10 ETOH abuse

My curiosity had me google "F10.10" and I found the following.

ICD-10-CM F10.10 is grouped within Diagnostic Related Group(s) (MS-DRG v35.0):

• 894 Alcohol, drug abuse or dependence, left ama
• 895 Alcohol, drug abuse or dependence with rehabilitation therapy
• 896 Alcohol, drug abuse or dependence without rehabilitation therapy with mcc
• 897 Alcohol, drug abuse or dependence without rehabilitation therapy without mcc

So with regards to FAA medical history, you definitely have "alcohol dependency" in your discoverable medical files.

 

[AggieMike88]

It was Chlordiazepoxide

So I looked up the drug.

With the properties listed in the second paragraph there, no way is the FAA going to let someone taking that drug to operate an aircraft.

Chlordiazepoxide, trade name Librium, is a sedative and hypnotic medication of the benzodiazepineclass; it is used to treat anxiety, insomnia and withdrawal symptoms from alcohol and/or drug abuse.​

Chlordiazepoxide has a medium to long half-life but its active metabolite has a very long half-life. The drug has amnesic, anticonvulsant, anxiolytic, hypnotic, sedative and skeletal muscle relaxant properties.​

 

[bussy77]

Thanks for finding out that information, I was curious that if just because I had F10.10 on my medical records it would be considered in fact "dependence." And to answer your question honestly I'm not willing to become completely abstinent. I understand their reasoning so I can't fault the FAA. I understand flying can be really rewarding and fun, but at this stage in my life I'm not ready to give up drinking completely.

 

[bussy77]

Not that it makes a difference, but I'm not taking that drug at all anymore. It was a one time thing for the couple of days proceeding my attempt to sober up for a while. Since then I've had the occasional drink.

 

[murphey]

Thank you very much again Aggie, judging by his previous responses it seems very cut and dry. I would love to hear his insight to this specific issue, but I'm guessing the options are either expensive testing, evaluations, and complete abstinence or no certificate. If anyone else has anything to add, it would be greatly appreciated.

aeromedicaldoc.com

 

[bussy77]

Thanks, I will contact him.

 

[AggieMike88]

Not that it makes a difference, but I'm not taking that drug at all anymore. It was a one time thing for the couple of day proceeding my attempt to sober up for a while.

but at this stage in my life I'm not ready to give up drinking completely.

Unfortunately the statement in the second quote doesn't wipe out the first "attempt to sober up for a while".

And the "not ready to give up drinking completely" statement answers the "big picture" question.

So, mon ami, the cut and dry choice is flying or alcohol, and you are not permitted to choose any mixture of both.

My last bit of advice is to cease your flight training and don't go anywhere near an AME's office at this time.

I do wish you well and do hope you will find a place in your life where recovery from alcohol dependency is what you want.

 

[AggieMike88]

Thanks, I will contact him.

I wouldn't. The "not ready to be sober" comment in this thread will get you shot down very quickly.

Www.aeromedicaldoc.com is Dr. Bruce Chien. And he has indicated that he will only work with airmen who are willing to successfully make the long journey through lifelong sobriety.

Unfortunately, bussy77, you said you are not one of those. And Dr. Bruce has very short patience with folks who "don't get it" or "won't do it".

Wasting the good doctor's time today might prevent you from having access to his services later when you have committed to sobriety.

So I advise against contacting him at this time.

 

[bbchien]

Bussy, this is a very knowledgable group of aviators who do a remarkable service on their own.

They are correct. Once you are where you describe, you do have to give it up, and prove you have given it up, to even begin the journey to FAA-land.

 

[Lindberg]

Fortunately, not all flying requires an FAA medical.

 

[Palmpilot]

Wouldn't that require a medical as well?

No, sport pilot does not require a medical certificate, but among other things it does require that if you have ever applied for a medical certificate, then your most recent application must not have been denied:

14 CFR 61.3 excerpt:

(c) Medical certificate. (1) A person may serve as a required pilot flight crewmember of an aircraft only if that person holds the appropriate medical certificate issued under part 67 of this chapter, or other documentation acceptable to the FAA, that is in that person's physical possession or readily accessible in the aircraft. Paragraph (c)(2) of this section provides certain exceptions to the requirement to hold a medical certificate.

(2) A person is not required to meet the requirements of paragraph (c)(1) of this section if that person--

...(v) Is exercising the privileges of a sport pilot certificate with other than glider or balloon privileges and holds a U.S. driver's license. A person who has applied for or held a medical certificate may exercise the privileges of a sport pilot certificate using a U.S. driver's license only if that person--

(A) Has been found eligible for the issuance of at least a third-class airman medical certificate at the time of his or her most recent application; and

(B) Has not had his or her most recently issued medical certificate suspended or revoked or most recent Authorization for a Special Issuance of a Medical Certificate withdrawn.​

You would also have to meet the requirements of 14 CFR 61.53(c)(2) and (b):

(b) Operations that do not require a medical certificate. For operations provided for in §61.23(b) of this part, a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.

(c) Operations requiring a medical certificate or a U.S. driver's license. For operations provided for in §61.23(c), a person must meet the provisions of--

...(2) Paragraph (b) of this section if that person holds a U.S. driver's license.
​

 

[Dav8or]

No, sport pilot does not require a medical certificate, but among other things it does require that if you have ever applied for a medical certificate, then your most recent application must not have been denied:

14 CFR 61.3 excerpt:

(c) Medical certificate. (1) A person may serve as a required pilot flight crewmember of an aircraft only if that person holds the appropriate medical certificate issued under part 67 of this chapter, or other documentation acceptable to the FAA, that is in that person's physical possession or readily accessible in the aircraft. Paragraph (c)(2) of this section provides certain exceptions to the requirement to hold a medical certificate.

(2) A person is not required to meet the requirements of paragraph (c)(1) of this section if that person--

...(v) Is exercising the privileges of a sport pilot certificate with other than glider or balloon privileges and holds a U.S. driver's license. A person who has applied for or held a medical certificate may exercise the privileges of a sport pilot certificate using a U.S. driver's license only if that person--

(A) Has been found eligible for the issuance of at least a third-class airman medical certificate at the time of his or her most recent application; and

(B) Has not had his or her most recently issued medical certificate suspended or revoked or most recent Authorization for a Special Issuance of a Medical Certificate withdrawn.​

You would also have to meet the requirements of 14 CFR 61.53(c)(2) and (b):

(b) Operations that do not require a medical certificate. For operations provided for in §61.23(b) of this part, a person shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person knows or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner.

(c) Operations requiring a medical certificate or a U.S. driver's license. For operations provided for in §61.23(c), a person must meet the provisions of--

...(2) Paragraph (b) of this section if that person holds a U.S. driver's license.
​

This and Part 103 Ultralight as well as gliders. Since the OP has never been denied a medical, I say don't go near the medical, the AME and just go fly in one of these other categories. They are a lot cheaper too.

 

[Rushie]

Not that it makes a difference, but I'm not taking that drug at all anymore. It was a one time thing for the couple of days proceeding my attempt to sober up for a while. Since then I've had the occasional drink.

The reason they give that drug (or the one I mentioned, which is also a benzodiazepine) is because alcohol withdrawal can cause seizures which can be fatal. The benzos are anti-seizure meds. They bind to the GABA receptors which got all out of whack by the chronic alcohol use.

Here's what happens when you drink on a regular basis:

The brain is always trying to stay in equilibrium. It has a way to excite your nervous system and a way to calm it. Think of it as go juice and calm juice. The go juice is glutamate and your brain has receptors that it activates. The calm juice is GABA and the brain has GABA receptors. Too much of either is bad. Too much excitatory neurotransmitters and you have seizure, too much calm and you have extreme sedation.

Alcohol acts like calm juice. Drinking adds extra calm juice to your system. But because the brain wants balance, if you drink every day, it will make adjustments to try to keep you in the default state (neither overexcited nor overly sedated). Think of it as desensitizing the GABA receptors, so that the glutamate has a bigger effect. Over time, your brain will automatically stay at that higher excitatory set point, because it's expecting its daily influx of extra calm juice. This is tolerance and is when you find you must have a drink just to function normally. If you don't have a drink the go juice takes over hence seizure risk and the other symptoms of withdrawal.

This is a great oversimplification, but here is the point: Once changed, your brain remembers all this, and forever more, can ramp itself back up to the level of tolerance that once took a month to achieve, in far less time. This means, the occasional drink can very quickly become daily dependence again, insidiously.

This is why the FAA has a complete abstinence rule, once you have been diagnosed with dependence.

 

[AggieMike88]

Good explanation, @Rushie

 

[Kenny Phillips]

Thanks for finding out that information, I was curious that if just because I had F10.10 on my medical records it would be considered in fact "dependence." And to answer your question honestly I'm not willing to become completely abstinent. I understand their reasoning so I can't fault the FAA. I understand flying can be really rewarding and fun, but at this stage in my life I'm not ready to give up drinking completely.

My life didn't really begin until I stopped drinking, which I did because several family members had dependency issues, and I thought that it would be good to be a role model (I had never had a DUI or lost a job because of drinking). Then I found that the crowd I hung with were drunken idiots, and I had been one of them. After the day I stopped, thirty years ago, everything got better; I had more promotions, then better jobs, more money ... all rewards. It's a win/win. At least you are honest about not wanting to stop; most folks pretend that they need to stop, because of spouse/boss/etc.