When it comes to long-term recovery from addiction, two groups stand out far above the rest: doctors and airline pilots. Their success rates aren’t just impressive – they’re astonishing compared to national averages.
I first came across this fact in 1998, when a headline in the Hazelden Bulletin caught my attention: “Airline pilots soar to success in recovery. [i]” The numbers were remarkable. Pilots participating in their specialized recovery programs had a 92% continuous abstinence rate at two years. Soon after, I learned that physicians in state-run Physician Health Programs (PHPs) were achieving similarly high outcomes – 78% continuous abstinence at five years, often after a single treatment episode.
As Dr. David Carr and Dr. Robert DuPont observed,
Those are just over-the-top numbers for a chronic, progressive disease that kills people. [ii]
Where else in the addiction treatment field can you find results like that? Those results set an entirely new standard for recovery outcomes, one that every treatment program should aspire to.[iii]
Indeed, these results set a standard for recovery outcomes that the rest of the treatment field has yet to match.
One key reason these outcomes are so reliable is accountability. Doctors and pilots undergo regular, randomized testing for alcohol and drug use – unlike the general population, where success often depends on self-reporting or sporadic follow-up. Another crucial factor: both groups receive treatment programs specifically designed for their professions.
For physicians, the PHPs are operated by medical boards and tailored to the pressures and responsibilities of practicing medicine. For pilots, the Human Intervention and Motivation System (HIMS) – mandated by airlines – provides a similar structure of support, oversight, and gradual reintegration. These are not the same as mainstream treatment programs, and that difference is everything.
Coming from a family with a long history of alcoholism and failed treatments, I was both inspired and heartbroken when I learned about these outcomes. Inspired, because recovery clearly can work. Heartbroken, because programs like these are not available to everyone – people like my brother Rob. When I asked whether these successful protocols could be adapted for broader use, the answer was simple: No.
If this kind of disparity existed in cancer treatment – if one group had a dramatically higher survival rate – the public would never accept it. So why do we accept it in addiction treatment?
My brother Rob couldn’t understand why abstention was so elusive after inpatient treatment. In one of our last conversations, he wept with frustration and shame. But the truth is, Rob didn’t fail treatment – treatment failed him. He never had access to the kind of structured, accountable, and compassionate care that doctors and pilots receive through the PHP and HIMS programs.
PHP/HMS Program
So what makes the programs for physicians and pilots so effective? In essence, they combine accountability, structure, and compassion in ways that traditional treatment programs rarely do.
Both the Physician Health Programs (PHPs) and the Human Intervention and Motivation System (HIMS) use a simple but powerful incentive: the ability to keep one’s professional license. For doctors, that means the right to practice medicine; for pilots, the right to fly. This form of accountability is a classic example of behavioral reinforcement – a structured system that motivates ongoing compliance with treatment and recovery plans.
But incentives alone don’t explain the extraordinary success rates. The physician and pilot models differ from standard addiction treatment in quality, oversight, and duration. Participants receive comprehensive, evidence-based care that unfolds over many months, not just a few weeks. Their recovery is closely monitored by professional boards or regulatory agencies, which ensures consistent follow-through and early intervention if problems arise.
Today, Physician Health Programs are widely regarded as the gold standard in addiction recovery – programs that make long-term sobriety not just possible, but expected. A detailed evaluation of these programs, along with recommendations for adapting them to other populations, can be found in The New Paradigm of Recovery: Making Recovery – and Not Relapse – the Expected Outcome of Addiction Treatment, published by the Institute for Behavioral Health following a 2013 national symposium.
When adapted for broader use, the core principles of the PHP and HIMS models can transform outcomes for individuals and families alike. Key components include:
- Leveraging relationships and accountability – using family or community support to encourage treatment participation and follow-through.
- Long-term recovery management – extending structured support for many months or even years after initial treatment.
- Regular, supervised drug testing – ensuring ongoing abstinence through objective monitoring.
- Written recovery contracts – clear agreements outlining expectations and relapse plans.
- Recovery coaching and sober companionship – sustained, hands-on support through each stage of recovery.
- Family reconciliation and healing – addressing not only the individual’s recovery but also the relational harm caused by addiction.
These elements work together to create a framework of sustained accountability and compassionate structure – the missing ingredients in many traditional treatment programs. For more detail on how PHP principles can be implemented outside the medical profession, see my related writings and forthcoming blog posts.
Activist Paradigm Shift from Passive Existing System
Implementing the PHP and HIMS principles requires more than just new procedures – it calls for a paradigm shift in how we think about addiction and recovery. Instead of viewing treatment as a one-time event, this model recognizes recovery as a long-term, interactive process that requires structure, accountability, and ongoing support.
This stands in stark contrast to the traditional mindset still promoted by many treatment centers, interventionists, and even family support groups such as Al-Anon. Phrases like “letting go” or “waiting for them to hit bottom” reflect a passive philosophy – one that asks families to stand by and hope that the person suffering from addiction eventually decides to seek help on their own.
But hope alone is not a strategy. Too often, individuals finally enter treatment only to leave prematurely, convinced they can now manage their addiction. They return to the same environments, without structure or accountability, and relapse becomes almost inevitable.
Not surprisingly, some professionals and families resist this more active, leverage-based approach – arguing that it infringes on personal autonomy. Yet this objection overlooks a fundamental truth about addiction itself. As National Geographic described in its article “The Science of Addiction, [iv]” addiction is the “compulsive repetition of an activity despite life-damaging consequences. [v]” Brain imaging studies vividly illustrate how alcohol and other drugs alter brain structure and function, diminishing the very regions responsible for decision-making and self-control.
In other words, expecting a person with a compromised decision-making system to independently “choose” recovery is not just unrealistic – it’s contrary to the science.
Now consider how this plays out in real life. Many families continue to provide financial or emotional support to loved ones struggling with addiction – often through housing, tuition, or jobs in family businesses. When these supports continue without conditions, they can unintentionally sustain the addiction rather than the recovery.
So we must ask ourselves: Can we, in good conscience, stand by and wait for a loved one to “see the light”? Or is it more compassionate – and ultimately more effective – to intervene actively, using structured accountability and long-term recovery management to help them heal?
Therapeutic Leverage – Contingency Management
One of the hardest truths about addiction is that access to family resources can unintentionally sustain it. When loved ones continue to provide financial or emotional support without conditions, they often protect the addicted person from experiencing the natural consequences of their use. Without that external pressure, the disease is free to progress – leading to physical decline, emotional harm, and deep financial and relational damage.
We can no longer accept this “do-nothing” approach that asks families to wait, watch, and hope. It is outdated, ineffective, and, in many cases, dangerous – especially when we know that structured programs like those for physicians and pilots achieve extraordinary recovery rates. Remember, though, our goal is to transform resources into supporting recovery. Too often from anger or as a form of punishment users are “cut off”. While it may make family members feel better, it does not lead to successful outcomes. That’s why I call this therapeutic leverage.
The lesson from those programs is clear: accountability and incentives work. Families can learn from the core components of these models and apply similar principles to help their loved ones sustain long-term recovery. While finding counselors familiar with the physician or pilot model can be challenging, the underlying approach aligns closely with what is now known in the field as contingency management – an evidence-based method increasingly used to treat stimulant and methamphetamine addiction.
At its heart, contingency management is about reinforcing healthy behaviors. It uses structured incentives – positive consequences for compliance and progress – to encourage engagement in treatment and reduce relapse. When families adopt this mindset, they become active participants in recovery rather than passive observers of relapse.
Unfortunately, many counselors and programs remain firmly rooted in traditional models such as AA and Al-Anon, and may resist these more active, science-based strategies. For families seeking help, one simple way to identify a forward-thinking professional is to ask a screening question:
“What are your views on using incentives to encourage treatment compliance?”
If the counselor recognizes the value of contingency management, you’ve likely found someone aligned with evidence-based practice – and with a recovery model that gives your loved one the best chance for lasting success.
When I think about my brother Rob – and the many families who have watched a loved one cycle through treatment after treatment – the message is painfully clear: we can do better. The science, the outcomes, and the lived experience of thousands of physicians and pilots all point to the same truth: recovery thrives when structure, accountability, and compassion work together. Families should not have to stand by helplessly while outdated systems fail the people they love. By embracing proven, evidence-based approaches like contingency management and the principles of the physician and pilot programs, we can turn recovery from a matter of chance into a matter of design—and finally give our loved ones the same opportunity to heal that every doctor and pilot receives.
[i] Hazelden Voice, Vol. 3, Issue 1, Winter 1998
[ii] Dr. David Carr, Director, Mississippi Physicians Health Program
[iii] Dr. Robert DuPont, former Director of the National Institute on Drug Abuse:
[iii] For data supporting these outcomes, see The New Paradigm for Recovery: Making Recovery – and Not Relapse – the Expected Outcome of Addiction Treatment,A Report of the John P. McGovern Symposium Hosted by the Institute for Behavior and Health, Inc. November 18, 2013, Washington, D.C., March 2014 (available at www.billmessinger.com)
[iv] “The Science of Addiction.” National Geographic. September 2017
[v] “The Science of Addiction.” National Geographic. September 2017, p. 37