Life
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.
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:
"Despite the outward appearance of functionality, however, alcoholism never fails to take its toll... Initially, and even for many years, alcohol appears to mitigate stress. Simultaneously, however, it is making the drinker less resistant to stress and less able to withstand pressure. Over time, the alcoholic’s ability to cope decreases and more alcohol is required, setting up a destructive cycle of ever-increasing stress and an ever-increasing need for more and more alcohol.... Alcoholism is a progressive disease. Heavy drinking only gets heavier. Though an employee may be performing adequately at the moment, at some point the disease will take over and usurp that performance."
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.