Abstract
INTRODUCTION: An Australasian Airline's Alcohol and Other Drug (AOD) Program demonstrates abstinence rates that exceed those of general AOD programs. The reasons for this are unclear.The purpose of this research was to develop a theory as to why this program is successful. METHODS: A qualitative examination following grounded theory methodology was undertaken. AOD program patients and healthcare professionals were interviewed until content saturation was reached. Data analysis followed grounded theory to identify the key concepts associated with the program's success. RESULTS: The core theory that emerged highlighted the pivotal roles of a strong employee-company relationship, shared values, and a safety -focused culture in explicating the program's success. This moves beyond the carrot and stick" model of motivation, where belonging to this organization and safety consciousness serve as powerful drivers for abstinence. Challenges and barriers highlighted some unique challenges to the program in managing the coronavirus pandemic and the difference in approach to substance use in community spaces versus safety -critical employment. DISCUSSION: This research expands the understanding of this AOD program's success in a safety -critical industry, emphasizing the elements of a working relationship that are beyond positive or negative reinforcement. Future research should work to quantify and test the generalizability of these findings.