For most flight attendants, it’s a pleasure to sling diet cokes in the sky. On anonymous job review sites, cabin crew members report working alongside “amazing people” and making the most of an “awesome opportunity” to travel the world. After all, they’ve beat out tens of thousands of wannabes for the privilege and its perks—including the legendary post-work partying.

But not everyone finds it easy to know when to call an end to the festivities. On cabin crew subreddits, insiders josh with one another about the industry’s boozier side. “If anyone in the airline or public safety industry said they don’t drink, it’s one of two things. Either they’re a recovering alcoholic or a liar,” said one. For some, that’s a problem: The dizzying highs of the airborne lifestyle can come with a side of abject lows, including poor mental health, sleep disorders, and substance abuse issues. Those factors compound, with crew members sometimes resorting to alcohol and prescription drugs to combat sleeplessness or anxiety, said Adrianna, a flight attendant of more than 10 years with a major US airline. (She asked Quartz not to identify her employer due to concerns about losing her job.)

“A lot of us are suffering from really bad anxiety, being trapped in a tube with people all day,” she said. “We’re not allowed to show our real emotions, ever. I actually swear in my sleep and scream, and I swear it must be because I’m not allowed to express my emotions all day.”

Every now and again, these issues result in dramatic, splashy headlines, particularly around alcohol abuse: In 2019, a flight attendant made the news for being visibly drunk on a United flight from Chicago to South Bend, Indiana. The same month, a Qantas employee lost her job after she was found to have drunk a quarter of a bottle of vodka between Johannesburg, and Sydney. In one memorable case in 2010, Steven Slater, a flight attendant with JetBlue, activated the plane’s emergency slide and exited the plane clutching two cans of beer. He had been struggling with bipolar disorder and substance abuse at the time of the incident, he told Quartz.

While the particulars may have been unusual, the root cause is not. “I’ve lost friends,” said Adrianna. “They’ve gotten fired, but I also lost a friend last year. He’d been let go for alcohol, and then he just wouldn’t stop. And then he died.”

Unique pressures

If the occasional flight is wearying, imagine the exhaustion of doing it for a living. Cabin crews spend long hours on their feet in an airborne, pressurized container. Then there are the customers, who may be stressed, anxious, or simply unpleasant. Crew members must keep a smile on their dial—or risk losing their job. Despite many hours spent on layover or sitting on the tarmac, flight attendants are only remunerated when the plane doors are shut. Meanwhile, constantly shifting from one time zone to the next wears on the body: Jet lag symptoms include mood swings, fatigue, or a perennially upset stomach. But once you’re in, it can be hard to quit—especially as salaries and hours improve as flight attendants move up the ladder. Those who do leave face an uncertain path: The route on to other career opportunities can be circuitous at best, especially for those who leave the airline altogether.

Cabin crews get through it all together, often over drinks. As one recovering flight attendant said “This is an environment where many people who love to drink, myself included, fit right in.” Post-flight, crew “debriefs,” as they’re known, generally begin and end at the bar of a hotel that may be a long way from town. Often, the only sober alternative is solitary channel-surfing. Such unsociable crew members are referred to disparagingly by their peers as “slam-clickers,” for the sound of a locking door.

“You think it’s all innocent, until you’re drinking by yourself in your room.”

There are plenty of reasons you might opt to drink, said Slater, who worked for TWA and Delta before moving to JetBlue. “The fact that you’re away from home, you’re away from your social support, you miss your holidays, you miss your weekends. You’re isolated a lot. It’s going to be very, very lonely. So it is kind of a perfect storm. It does set itself up to be very troublesome.” Current flight attendant Adrianna gave up drinking more than a year ago. At times, she found it hard to know when to stop: “You think it’s all innocent, until you’re drinking by yourself in your room, and it’s no longer a social thing.”

Given the stigma associated with seeking help, it’s unclear precisely how common these stories are, said Heather Healy, who manages Flight Attendants Drug and Alcohol Program (FADAP), a FAA-funded safety initiative: “We did some anonymous surveys back in 2000 with flight attendants, just asking them to share information about what they were doing,” Healy said. “The number of safety violations—drinking past the cut-off time, using medication and drinking, borrowing medication from others—well, it was off the Richter scale. The problem is there, we’re not in denial of that.”

Some flight attendants manage anxiety or depression with highly addictive prescription drugs, including sleep medication or opioids to manage pain. “You’ve got a cluster of occupational issues that promote a drinking environment,” said Healy, “but also use of alcohol and prescriptions to manage some of the issues that are part of the occupation—anxiety, stress, sleeplessness, and pain.”

Journey to sobriety

Like pilots, cabin crew are subject to random drug and alcohol testing, generally following serious aircraft accidents, or if fellow workers observe suspicious behavior. The FAA stipulates flight attendants may not drink in the eight hours prior to reporting for duty, and that blood alcohol level should be no higher than 0.04, or half the legal limit for driving. But many airlines have far stricter rules, including a maximum blood alcohol level of 0.001 or a twelve-hour drinking curfew. Legally, airlines aren’t compelled to terminate their crew on their first offense—though many do. (A second violation will always result in a flight attendant’s FAA certification being permanently revoked.)

Airlines’ approaches vary: In a statement supplied to Quartz in lieu of an interview, JetBlue said it had a zero tolerance policy for crew members who fail drug and alcohol tests. Those who actively seek treatment themselves, however, can enroll in “free voluntary treatment,” the airline said, which “allows crew members to get the help they need, while protecting their employment by JetBlue accommodating their leave.” American Airlines, meanwhile, allows crew members who have failed a single test to undergo an FAA-approved multi-month program, which may include in-patient treatment and daily AA meetings. If they successfully pass it, they may return to work. Crew and their families also have access to the airline’s free, confidential Employee Assistance Program, which provides access to counseling, legal or financial consultations, and other services.

“I just didn’t want them knowing my business.”

In the early stages of sobriety, Adrianna approached Alcoholics Anonymous for help. It wasn’t the right fit, she said, with a seemingly rigid treatment plan that could make few allowances for the vagaries of crew life. Going to a meeting every day was out of the question, she said, especially on travel days when she scarcely finds the time to brush her teeth. “When you’re working, you’re all over the place. You might be in the middle of the United States on a layover; you might be in the Dominican Republic,” she said, where such meetings may be hard to find. She considered asking her employer to help her give up drinking, but worried she might be referred to in-patient rehabilitation at heavily reduced pay, or find herself under constant scrutiny on a multi-year probation. “I really didn’t want to bring my work into it, if I didn’t have to,” she said. “I just didn’t want them knowing my business.”

A profession with unique pressures

Most 9-to-5 occupations don’t require their own specific treatment plan. But the unique pressures of flight attendants’ lifestyles can complicate recovery: They are at high risk of occupational injury, including back problems, stress, and shift work disorder, which can result in excessive sleepiness or losing consciousness for seconds at a time. As on-the-go, airborne bartenders, serving alcohol to passengers may be a trigger. Ordinarily, patients in the early stages of recovery are advised to avoid becoming what’s commonly known as HALT—”Hungry, Angry, Lonely or Tired”—any of which can increase the risk of a relapse. For flight attendants, such states are practically the norm. There are other complicating factors: Flight attendants are overwhelmingly female; as of 2018, men made up a little over 20% of all stewards in the US. From a treatment perspective, Healy said, that’s relevant—many women come to the profession with a history of trauma, often related to sexual assault.

As recently as 2009, however, there was no designated service for flight attendants battling addiction or substance abuse issues. Since the 1970s, pilots have been able to turn to HIMS (the result of a research project, called Human Intervention Motivation Study), which offers services ranging from substance abuse education to rehabilitation referrals. But those working on the other side of the cockpit door were not eligible.

In April 2009, Patricia Friend, the then-president of the Association of Flight Attendants union, appeared before the Subcommittee on Transportation, Housing and Urban Development to request funding for a flight attendant-specific program. Flight attendants were if anything at greater risk of developing substance abuse issues, she said, “because they may be exposed to multiple traumatic and near-traumatic incidents while on the job,” including as first responders in moments of crisis.

85% of flight attendants who used FADAP’s services said they would do so again

This, and other pushes from industry leaders, ultimately resulted in FADAP, a peer-led program designed to keep flight attendants—and passengers—safe. Flight attendants can reach out to the service themselves; alternatively, concerned family members of unwell flight attendants may contact the service instead of the airline itself, to avoid putting their loved one’s job in jeopardy. (If you Google “flight attendant alcoholic,” it’s the very first result.) Often, flight attendants are referred to FADAP after someone else in the crew notices them lingering on the bar stool or displaying other worrying behaviors.

The support on offer includes biweekly Wings of Sobriety call-in meetings, peer mentorship, and a flight attendant-specific 12-step program. (The program can also refer crew members to in-patient treatment.) Together, the combination seems to work: In a 2015 study by researchers at the University of Maryland, more than 85% of flight attendants who used FADAP’s services said they would do so again, or recommend it to another flight attendant in need. Their attendance and dependability improved, they said, as did “work performance and safety, physical and mental health, coworker and customer relations, and engagement after completing treatment.”

Moving on

If a flight attendant is caught violating drug or alcohol regulations, FADAP can help, said Healy. “Everyone [at FADAP] is shifting not to try to help save your job, but to save your life, because the chances of you getting well, once you lose your job and lose your health insurance—those chances drop significantly.” At the same time, she said, the risk of suicide soars. Per FAA regulations, terminated flight attendants may rejoin the profession with another employer, but only after successfully completing a recovery program.

Not everyone returns to the skies. For some flight attendants, Healy said, being in the occupation can trigger a relapse. “From a long-range health perspective, getting out of it may be the best thing,” she said. This is especially true of flight attendants for whom a chemical dependency problem goes hand-in-hand with psychiatric disorders such as bipolar disorder, where disrupted circadian rhythms may precipitate manic and depressive episodes. “The trick may be that being a flight attendant is your worst nightmare, in terms of stabilizing your psychiatric illnesses,” she said. “Let’s get you doing something else.”

After his dramatic exit from Jetblue, Slater has not returned to aviation. He recently finished a memoir about his life, Wingwalking, but has since struggled to find other work. “If I was still flying, I would be doing lucrative international runs and making a lot of money and working 15 days a month,” he said. “But that’s not the way my story unfolded. So I’m out here, trying to make this transition, and I’m really having a hard time of it.”

“Flying is definitely a lifestyle, and it is very, very hard for others to understand.”

Slater’s experience is not uncommon: For flight attendants forced out of the profession, it’s not always obvious where to go next. Former stewards commiserate online in career-change forums about their apparently limited choices: ”I’m too old to go back to school and I don’t want to work for $12 an hour,” wrote former flight attendant Tom, after 24 years in the air. Dianne, who spent 23 years flying, found herself depressed and despondent after leaving the airline. “Your social network, your emotional support system, your paycheck, your flexible lifestyle, basically your whole life is centered around the airline,” she wrote. “You have to build all those relationships that you had in the airline, out of the airline.”

Even former crew members with a more successful transition to other careers found adjusting to the daily grind a wrench. “Flying is definitely a lifestyle, and it is very, very hard for others to understand,” noted Katlyn, who got a masters in nursing after leaving United Airlines.

Those who can no longer fly due to health reasons or particular life events, meanwhile, sometimes explore careers elsewhere in the airline. American Airlines often looks to reposition cabin crew for whom flying may no longer make sense, its spokesperson Derek Walls told Quartz. “It all depends on that person and what they’re interested in,” he said. “We do a pretty good job at hiring from within for roles that someone might find suitable, or if they want to explore different areas of the operation.”

Lately, Adrianna has begun to wonder about re-establishing her life on the ground. The question is, she said, “where am I going to get paid this much money and have this much time off? It gets addictive in that sense. I don’t necessarily want to be away from my family, and I don’t want to do overnight flights, but what the hell else am I qualified for?” Still, she said, there could be upsides in saying goodbye to the perks. “I wouldn’t be opposed to going to bed every night and getting up in the morning,” she said. “I think that would be kind of dreamy—to go to bed when it’s dark, get up when it’s light.”