Addiction Is Not a Disease — And the FAA’s HIMS Program Is Built on a Flawed Assumption

A closer look at addiction science, long-term aeromedical monitoring, and why pilots and air traffic controllers deserve a framework grounded in measurable risk, transparency, and modern evidence.

A recent article by psychologist Constantin Patrascu, “I’m a Psychologist and Addiction Is Not a Disease,” challenges one of the most widely accepted assumptions in modern addiction treatment: the belief that addiction is a chronic, lifelong disease.

For decades, the “disease model” has shaped treatment programs, public messaging, and recovery culture. In aviation medicine, however, the consequences of this assumption are especially significant. It increasingly influences how the Federal Aviation Administration evaluates substance-related cases involving both pilots and air traffic controllers.

In recent years—particularly following recommendations from the National Transportation Safety Board (NTSB)—the FAA has leaned more heavily into the idea that substance use disorders represent a chronic medical condition requiring extended monitoring.

As a result, aviation professionals suspected of alcohol or substance misuse are often placed into multi-year monitoring programs, and in some cases career-long oversight, even after demonstrating years of sobriety and stability.

But what if the central premise behind this system is flawed?

The Disease Model Behind the System

The disease model of addiction gained traction in the 1990s when neuroscientists began identifying measurable brain changes in people with substance use disorders. These changes were interpreted as evidence that addiction was fundamentally a brain disease requiring medical treatment.

This framework helped shift public perception away from the idea that addiction was simply a moral failing. It also expanded insurance coverage and legitimized treatment programs.

But the conclusions drawn from those findings have increasingly been challenged.

One key point raised in Patrascu’s article is that brain changes do not automatically mean disease. The human brain is constantly rewiring itself in response to experience—a process known as neuroplasticity. Learning new skills, building habits, and adapting to new environments all produce measurable changes in brain structure.

Addiction reflects the same learning processes.

In other words, the brain changes associated with addiction may represent adaptation and reinforcement, not permanent pathology.

The Risk of Outdated Science

For regulators responsible for public safety, relying on outdated scientific assumptions can create its own form of risk.

Aviation medicine policies influence the careers of thousands of pilots and air traffic controllers and shape how substance-related cases are evaluated across the entire system. If those policies are built on scientific models that no longer reflect current research, the result may be a framework that imposes extensive monitoring without a clear evidence-based justification.

Modern behavioral science increasingly recognizes that substance use disorders exist along a spectrum and that long-term outcomes vary widely depending on individual circumstances, environment, and recovery pathways.

When regulatory systems fail to adapt as scientific understanding evolves, oversight mechanisms intended to enhance safety can instead become rigid structures that persist long after their original assumptions have been challenged.

What Addiction Often Represents

According to clinical observations discussed in the article, addiction frequently emerges as a response to underlying problems such as trauma, anxiety or depression, social isolation, overwhelming stress, and unresolved emotional pain.

Substances or addictive behaviors often provide temporary relief from these conditions.

In that sense, addiction is often not the root problem, but rather a coping mechanism for another problem.

Over time, however, that coping mechanism can become destructive and self-reinforcing.

But when the underlying life circumstances change—through stability, relationships, purpose, or improved mental health—the behavior often disappears.

The Overlooked Reality: Many People Recover

One of the most significant findings in addiction research is something rarely discussed in institutional programs:

Large population studies show that a substantial portion of individuals who once met diagnostic criteria for substance use disorder no longer meet those criteria later in life.

People often stop because life changes. They develop careers, families, responsibilities, and support systems that make the addictive behavior unnecessary.

Diseases rarely disappear simply because someone’s life circumstances improve.

But behavioral adaptations often do.

Environment Matters More Than Many Assume

Research repeatedly demonstrates that context and environment play a powerful role in substance use behavior.

Addiction is deeply influenced by life circumstances, social environment, and stress—not simply brain chemistry.

Where the FAA’s Framework Breaks Down

The FAA’s mission to ensure aviation safety is essential. Substance misuse among safety-sensitive professionals must always be taken seriously.

However, problems arise when regulatory systems rely on overly simplified scientific assumptions.

The current framework often treats substance use disorders as if they represent permanent medical conditions requiring extended monitoring—even when individuals demonstrate long-term sobriety and stability.

A Better Way Forward

What aviation medicine currently lacks is a transparent, evidence-based framework that evaluates real risk over time and provides a clear pathway back to unrestricted certification.

One concept proposed by reform advocates is AEROPath — the Aviation Evaluation & Recovery Oversight Pathway.

• objective clinical evaluation
• transparent diagnostic criteria
• independent medical oversight
• data-driven testing protocols
• clear exit points from monitoring

The goal is not to weaken aviation safety. The goal is to modernize it.