What Is "High-Functioning" Alcoholism & Why Is It So Difficult To Recognize?
Most of us are familiar with the concept of the "high-functioning" (or just "functioning") alcoholic — a person who, contrary to popular stereotypes about addicts, manages to hold down a job, pay their rent, and otherwise maintain the appearance of a life untouched by addiction issues. But real information about high-functioning alcoholics — and how to know if you or someone you love may be one — is in relatively short supply. Sarah Allan Benton, in Understanding The High-Functioning Alcoholic, explains that many of our contemporary understandings and definitions of alcoholism and addiction leave room for high-functioning alcoholics to "slip through the cracks," in part because of a comparative lack of scientific studies specifically focused on functioning alcoholics in particular. But understanding how this type of addiction functions is important — because high-functioning alcoholism can be just as damaging to the addict and their loved ones as very clear and obvious alcoholism.
In the most basic sense, a functioning alcoholic is one that, according to the definition of the rehab center Gateways, "can hold down a job, pursue a career or care for children while continuing with his or her alcoholism;" a high-functioning alcoholic does these things with extreme success and no apparent impairment. In these contexts, diagnosing the alcoholism itself can be exceedingly difficult, particularly for outsiders. However, the questionnaire for Alcohol Abuse Disorder found in the DSM-V, the diagnostic publication of the American Psychiatric Association, shows that people can fit the measures of a severe drinking disorder — inability to quit drinking, tendency to put themselves in situations where they may get hurt, experiences with withdrawal — while still appearing outwardly like perfectly healthy beings with functional lives. And that makes for a very dangerous combination — not just because it may discourage loved ones from urging the alcoholic to seek treatment, but because it may keep anyone from recognizing that a problem even exists.
Many High-Functioning Alcoholics Have A Difficult Time Believing That They Have A Serious Problem
Alcoholism, like all addictions, is deceitful. It insists to the addict that their behavior is perfectly normal and that there's no problem whatsoever. And the conditions that are required to break through this extensive, entrenched denial — "it's only one", "I have a stressful job", "I can quit whenever I want" — are often pretty extreme. There's a reason why "hitting rock bottom" is a thing in the rhetoric of addiction recovery. And for high-functioning alcoholics, that moment of "rock bottom" may never realistically come.
The stereotype that alcoholism is necessarily deeply harmful to your economic situation isn't actually true; only around 10 percent of all alcoholics are homeless or otherwise deeply "low-functioning." In the presence of apparent material security, good reputation and only "minor" penalties for an addiction, high-functioning alcoholics are a lot less likely to be able to admit to themselves that they have an issue, and that thinking can impede treatment and successfully dealing with it.
There is no such thing as a "good" alcoholic or someone who is "able to handle" their alcoholism: the ability to continue to live in a state of relative normalcy also means a tendency to be able to screen oneself from the realities of their addiction.
Its Effects On Family & Friends Are Hidden
The high-functioning alcoholic's story is largely one of appearance; the visible trappings of success mask a greater issue, disguising its impact from all except the closest and most intimate acquaintances. High-functioning alcoholism may not mean that the alcoholic's family becomes bankrupt or deals with alcohol-related violence, but it does alter the emotional dynamics significantly, creating unhealthy balances as well as the additional issue that nobody outside the family truly "sees" what's going on.
The outward success of a high-functioning alcoholic may, perversely, restrain their family from confronting them about their drinking; even when the alcohol abuse becomes emotionally destructive or creates deep rifts within the family, loved ones may hesitate because "nobody will believe me," "I don't want to embarrass them," or "they're doing all right, I have nothing to complain about." The situation is also obscured from outsiders because of the visible trappings of an effective, happy life, so there's not much chance of anybody else perceiving the truth of the situation. The result? An isolating family experience that can never really confront the issue head-on.
Some Work & School Cultures Can Help High-Functioning Alcoholics Lie To Themselves About Their Problem
High-functioning alcoholism can also have the complicity of the surrounding culture. Heavy drinking is, in certain cultural circumstances, entirely welcomed and understood, meaning that people who are otherwise successful are much less likely to question their own alcohol habits and wonder about addiction. The American college experience is an example — binge drinking and blacking out are just "what you do" when you're in college in many parts of the US, and that sort of acceptance of extreme behavior can make it very difficult for high-functioning alcoholics to pick up on any of their own issues.
Working high-stress jobs is another example; if the workplace culture embraces nightly heavy drinking sessions after deals and boozy lunches with clients — and there's no obvious impact on work ethic or ability — it's not exactly going to be a place that begins to ask questions if somebody's becoming too reliant on wine.
Our concept of addiction as "obvious" means that the non-obvious types can hide in plain sight. (Benton noted to the New York Times that bosses can be exceptionally well-camouflaged alcoholics because they're not supervised and aren't questioned.)
Being High-Functioning Does Not Protect You
There is a risky tendency, even among the high-functioning alcoholics who acknowledge they have a problem, to categorize themselves as somehow "better" than low-functioning ones. But having the trappings of a "functional" life does not make alcoholism any less destructive, or make a drinking problem any less real.
A 2015 study found that, of a cohort of nearly 500 highly educated young men, 14.5 percent were alcohol-dependent and 18.2 percent reported alcohol abuse in their past. As the study tracked them over the course of five years, they showed vulnerability to becoming alcoholics, despite receiving many social and cultural advantages and being, as the scientists noted, "high-functioning." The big predictors for alcohol abuse in the future, they noted, were a family history of alcohol problems, a personal history of alcohol abuse, and drug use — in other words, factors that being "high-functioning" does not help you escape.
And, as the famous rehab center Promises notes, alcoholism of any kind is never truly high-functioning. The fact of dependence will catch up to you in the end:
According to research from 2016, functional addiction isn't more common in either gender, and functional addicts tend to be middle-aged, have college education and steady jobs, and possess both a spouse and children. But while high-functioning alcoholics may look healthy, there is no "good" or "reasonable" level of alcohol addiction. Just because a drinking problem isn't ruining an addict's career or financial situation, doesn't mean that it isn't real.
If you think you or someone you love may be struggling with alcohol addiction, visit the National Institute on Alcohol Abuse and Alcoholism for more information on alcoholism, treatment, and recovery.