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Substance Abuse in Aviation: Clinical and Practical Implications
Published in Carrie H. Kennedy, Gary G. Kay, Aeromedical Psychology, 2013
If a substance abuse problem is suspected, the pilot is referred for an evaluation with a specialized clinician or at an alcohol treatment facility. A confirmed diagnosis will result in the pilot being grounded along with an offer of participation in the HIMS program, which typically begins with inpatient treatment. The inpatient treatment program involves at least a 28-day rehabilitation program, the successful completion of which leads to aftercare. This, in turn, involves at least 90 AA meetings in 90 days, group and individual therapy, developing and maintaining a constructive relationship with an AA sponsor and continuing the process of working the steps outlined by AA. Additionally, the pilot has to attend meetings with the designated chief pilot from his airline, who monitors his recovery. This can also include, separately or in combination, meeting with the airline’s Employee Assistance Program (EAP), as well as union representatives. Complete, permanent and verifiable abstinence is a necessary requirement for the Special Issuance of pilots diagnosed with Alcohol Dependence. No earlier than five or six months from the beginning of rehabilitation, and in accord with the HIMS AME working the case, the pilot is referred for the P&P examination. These are two independent evaluations, conducted separately by a board certified psychiatrist and a board certified (or board eligible) clinical neuropsychologist, both of whom have completed HIMS training in substance abuse and who are familiar with the cognitive and personality demands of aviation, and with FAA regulations pertaining to substance abuse and dependence. The report of the P&P evaluators are submitted to the pilot’s HIMS Aviation Medical Examiner (AME), who submits the package to the FAA for review and possible authorization of a Special Issuance medical certificate. The particular limitations and provisions of the Special Issuance will vary depending on the particulars of the case but invariably is conditioned upon permanent and complete abstinence. The pilot will be followed up frequently by the HIMS AME and will usually follow up with the psychiatrist on an annual basis. Follow-up neuropsychological services may also be considered.
Alcoholism detection based on Hu moment invariants of event-related potentials
Published in Journal of the Chinese Institute of Engineers, 2019
Addiction-based diseases are an important concern in our society. Alcoholism, also called alcohol dependence (AD), is an addictive disease that is defined as a behavioral cluster, with emotional, physiological and cognitive phenomena developing after repeated use of alcohol. Various modalities, including neuroimaging, psychology, psychopathology, neurophysiology, genetics, and biochemistry evaluations, have been used to investigate alcohol-induced changes in brain function in alcoholics; all have demonstrated that AD affects the structure and function of the brain (Bjork and Gilman 2014). Thus, AD causes neurological damage such as behavioral abnormalities, learning, and memory weakness as well as impaired decision-making. The effects of AD on brain functions have been investigated by using various techniques, including magnetic resonance imaging (MRI), functional MRI, positron emission tomography and electroencephalography (EEG) (De la Monte and Kril 2014; Oscar-Berman and Marinkovic 2003; Wang et al. 2017). EEG is the most commonly used method in clinical practice to investigate brain functional changes under different conditions because it is easy, portable, noninvasive, economical, and allows long-term recording. Nevertheless, localization of changes in cognitive activity is limited in EEG in contrast to brain imaging techniques. Compelling electrophysiological evidence indicates abnormalities of the brain, especially frontal dysfunction, in people with AD (Moselhy, Georgiou, and Kahn 2001; Oscar-Berman 2012). Abnormal frontal and prefrontal functioning can lead to cognitive deficits in areas such as attention, working memory, planning, decision-making, inhibitory control, and emotional regulation (Catani et al. 2012; Oscar-Berman 2012). Many studies have employed safe, noninvasive psychophysiological methods, such as EEG and event-related potential (ERP) analysis, to study the neural correlations of mental processes; some of these include EEG- and/or ERP-based studies of cognitive deficits in people with AD (Acharya et al. 2014; Balli and Palaniappan 2008; Faust, Yu, and Kadri 2013).