Human Intervention Motivation Study

The Human Intervention Motivation Study (HIMS), also known as the FAA HIMS program, is a United States Federal Aviation Administration (FAA) program that coordinates the identification, treatment, monitoring, and return-to-duty process for aviation professionals with substance use disorders or other conditions requiring FAA special issuance medical certificate review. Established in 1974 with support from the FAA, the Air Line Pilots Association, International (ALPA), and funding from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the FAA describes HIMS as "an effective program that allows safety-sensitive employees to return to work in a safe and structured manner," and the program is supported by major airlines, pilot unions, and aviation industry organizations. FAA medical certification is required for pilots, air traffic controllers, flight engineers, flight navigators, and other aviation personnel; while originally developed for airline pilots, HIMS evaluations and monitoring are performed on all certificate holders requiring FAA medical clearance, including air traffic controllers and Aviation Safety Inspectors. The program has expanded to include pathways for post-traumatic stress disorder and attention deficit hyperactivity disorder. As of 2021, approximately 12,000 pilots have been returned to flying under HIMS supervision since the program's inception.

The program requires participants to undergo monitoring including random drug and alcohol testing using ethyl glucuronide (EtG) and phosphatidylethanol (PEth) biomarkers, attendance at peer support meetings, and oversight by specially designated HIMS Aviation Medical Examiners, with a minimum monitoring period of seven years and effectively lifetime special issuance medical certification under current policy. Testing costs are borne by participants, with first-year expenses ranging from $8,000 to $15,000. The Substance Abuse and Mental Health Services Administration (SAMHSA) has warned that EtG tests "should not be used as the sole basis for legal or disciplinary action." Program stakeholders have acknowledged that claimed outcomes depend on coercive leverage over participants' careers rather than therapeutic efficacy alone.

A 2023 National Academies of Sciences, Engineering, and Medicine study—the first independent review in the program's 49-year history—found "no solid evidence" supporting HIMS's claimed 85% success rate and concluded that effectiveness claims "could not be substantiated," noting that the FAA and ALPA had declined to provide outcome data to congressionally mandated researchers. The committee noted that without access to the underlying data, it could not "resolve questions that arose during the study about the quality of HIMS data and data systems." The study also found that HIMS treats roughly 1.5 percent of pilots despite research suggesting 13 to 15 percent may have a substance use disorder, attributing this gap in part to fear of career consequences—a concern the FAA's own Mental Health Aviation Rulemaking Committee later identified as "the most prevalent and serious barrier" to seeking treatment.

Several legal cases have challenged program-related practices, including whistleblower retaliation through psychiatric evaluations, religious and racial discrimination, mischaracterization of medical conditions as substance use disorders, disputed biomarker testing, and allegations that airlines use HIMS referrals to manage employees rather than address genuine clinical concerns. In 2025, a Florida jury awarded $513,000 to a pilot whose HIMS Aviation Medical Examiner erroneously attributed another pilot's positive blood test to him, the first known jury verdict finding a HIMS AME negligent. Fear of disclosure has been linked to pilot suicides, and the House of Representatives unanimously passed the Mental Health in Aviation Act in September 2025, requiring the FAA to implement recommendations from its rulemaking committee; pilot advocacy organization Pilots for HIMS Reform has argued the legislation does not address structural HIMS issues including due process deficits and testing protocols documented by the National Academies study. The HIMS model has been adopted internationally in Australia, New Zealand, Hong Kong, and several European countries.