Drunken pilot reporting for duty (1) may have made headlines, in turn setting various fora abuzz with strong public opinion ranging from strong action against the pilot to the need for a sympathetic view. Indeed, if one looks at this incidence from the perspective of aviation safety, the pilot, if he had gone unnoticed, was jeopardizing safety of his passengers besides breaching the practices of good conduct and company policy, thus rendering himself liable for criminal actions. But seeing it from an individual point of view, what is it about ‘alcohol’ which has now brought his professional career to a grinding halt! Or stated another way, what is it that leads to such a dependence on alcohol for a professional pilot to jeopardize his career and the safety of those under his care?
An individual is afflicted with ‘Alcohol Dependence’ when he nurtures a strong desire for, and continues repeated consumption of alcohol, with inability to control its use, despite adverse/harmful consequences including personal or social obligations, with a state of physical dependence and if denied, withdrawal (2, 3).
There are a variety of factors making a person abuse alcohol. In airline industry, as in military or college settings, consumption of alcohol is not just expected but is socially acceptable. Aircrew, in addition, spend many days away from home, at different locations isolated from their family and social circle. They also have to cope with the travails of the circadian rhythm when flying international routes. It is here where alcohol comes as an easy relief, both to relax after a long day at work and to retire for the night. It is believed that the feelings of euphoria and well-being, under the influence of alcohol, can encourage a pattern of repeated consumption.
Personality too may play a role in turning one into a compulsive alcoholic. Especially vulnerable are the shy, isolated, impatient, irritable, anxious, hypersensitive, or sexually repressed individuals who can transform into one who feels all-powerful, with an inflated self esteem when under the influence of alcohol. It is known that the ‘superego’ (the policeman within) gets dissolved into alcohol, making the meek believing himself to be all powerful and mighty! So also, experiences in the childhood may turn one into an alcoholic – sons of alcoholic fathers are more likely to become alcohol dependent themselves. Alcoholics are more likely to have relatives who are also dependent on alcohol or other substances.
Alcohol Dependence is therefore a behavioural pattern, aptly considered a disease, in which the use of a given psychoactive substance, the alcohol, assumes a much higher priority than other behaviours that once had a much higher value. The pattern of consumption may vary tremendously, from weekend binging to the habitual use of small amounts daily, or a combination of the two. There are certain pointers to alcohol abuse including head trauma, social and occupational deterioration, and features of alcohol withdrawal/physical damage. Interestingly, these tell tales signs are there for the close family members, relatives, friends and supervisors to see. But, buying domestic peace by the spouse, protective supervisors or “good-weather” friends help the individual continue sliding down the path of self destruction – professionally, socially and in matters of personal health.
Yet it may help those who are interested to know that alcohol dependence is diagnosed, if three or more of the following have been present together at some time during the previous year:
- Strong desire or sense of compulsion to take alcohol.
- Difficulties in controlling alcohol-taking behaviour in terms of its onset, termination, or levels of use.
- Physiological withdrawal state; or use of the alcohol to relieve or avoid withdrawal symptoms.
- Evidence of tolerance
- Progressive neglect of alternative pleasures due to alcohol use, increased amount of time spent in obtaining the substance or recovering from its effects.
- Persisting with alcohol use despite clear evidence of harmful consequences – social, occupational or health.
- Spending time to obtain alcohol or recovering from its effects.
There are several questionnaires which individuals can undertake to determine if their alcohol consumption is harmful. One such is Alcohol Use Disorder Identification Test (AUDIT) (4), WHO’s online test to determine harmful alcohol consumption by an individual.
It is vital to understand that an alcoholic may have to be coerced, pressured or otherwise encouraged to join treatment. More importantly, very few people accept the fact that alcohol is a disease and thus, resist interventions. However, the goal of the alcohol treatment/rehabilitation programme is complete abstinence. The corner stones of treatment are forced abstinence, detoxification, motivation enhancement to maintain abstinence, individual, and group therapy. Social and behavioral skills training and enhancement of coping mechanisms are also used effectively, and this is where the family and social support plays a pivotal role.
Though the opinions vary whether to punish the erring pilot or to help him, it is vital to remember that if seen as a disease, alcohol dependence, is to treated, like any other medical illness. What is more important is that the people around have a vital role in helping the ‘patient’ seek help and to help him further on the road to recovery by providing constant encouragement and motivating him to abstain for his own good. Say cheers but with care!
2. WHO ICD Version 2007 Chapter V Mental and Behavioural disorders – Mental and behavioural disorders due to psychoactive substance use
3. Wikipedia – Alcohol Dependence
4. Alcohol Use Disorder Identification Test (AUDIT) – WHO’s online test to determine harmful alcohol consumption by an individual.
Acknowledgement: Image courtesy The Kathryn Aviation Report