The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that, in 2015, almost 27 percent of American adults, ages 18 and older, reported that they binge drank at least once in the month before responding to the National Survey on Drug Use and Health (NSDUH); 7 percent reported that they engaged in heavy alcohol use in the past month. In general, about 56 percent of American adults reported that they consumed alcohol in the prior month.
Binge drinking, heavy drinking, and alcohol use disorder are all forms of problem drinking, meaning that the person struggling with any of these conditions has difficulty moderating their consumption of the intoxicating beverage. They drink too much when they do drink, or they drink consistently every day for years. People with alcohol use disorder (AUD) cannot control their behavior around alcohol. They frequently consume more than they intend and experience intense cravings for alcohol when they are not drinking, despite damaging their family relationships, friendships, and even careers.
Interventions to Get Help for High-Functioning Alcoholics
Although many people close to a high-functioning alcoholic may unintentionally become enablers, they are likely to notice changes in a person suffering from AUD. These loved ones may want to help, but may be unsure how to convince the individual to seek treatment. With the popularity of reality television shows dedicated to interventions and treatment for substance abuse, family and friends may decide that an intervention is the best approach to convincing a high-functioning alcoholic that they should, and can, seek help.
As portrayed on television, interventions are tearful and intense. They do not have to be this way, and in fact, an emotional intervention may prevent the person from getting treatment, forcing them into further denial. Fortunately, there are approaches to those with AUD that can convince them to receive a diagnosis, pursue detox and rehabilitation, and maintain sobriety. Here are a few steps to take to successfully approach a loved one struggling with AUD:
- Find a time to talk when the person is not intoxicated.
- Clearly explain how the individual’s problem drinking impacts their relationships.
- Place emphasis on feelings and concerns, not on blame.
- Note specific instances when drinking escalated and became harmful to the relationship.
- Clearly state boundaries for the future, rescinding offers to cover for the individual if they are drunk or hungover.
- Offer to help the individual seek treatment.
Planning an intervention with a few close friends and family members, or seeking out a professional like an interventionist or therapist to lead the intervention, can make the process easier. Creating a plan in advance will help everyone clearly express their concerns, avoid blame, and make solid offers of help during treatment and recovery. However, even with a well-planned intervention, a person who is a high-functioning alcoholic may not accept the concern and offers of help, at first. It is important that everyone stick to their boundaries and stop enabling the behavior. Many interventions are successful, even after some time has passed when the person eventually realizes that their behavior is harmful.
What Is a High-functioning Alcoholic?
APA’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has an updated definition to help clinicians understand and diagnose AUD and other forms of problem drinking. To meet the DSM-5 criteria, a person doesn’t necessarily have to struggle with problems at work or home. People who appear to be doing well, and do not appear to physically and emotionally rely on alcohol, may still struggle with cravings and dependence. These individuals are colloquially called high-functioning alcoholics, but this term underplays the individual’s risk for mental and physical harm. Just because a person does not fit the stereotype of how an alcoholic looks or acts, it does not mean they do not suffer.
People who fall into the category of high-functioning alcoholics (HFA) go to work or school every day, have active social lives and hobbies, pay their bills on time, and keep up with their familial responsibilities to spouses and children. They may even achieve lofty career goals, work long hours, and have high salaries. While maintaining all of these normal, daily activities, these people drink, crave drinking, talk about drinking, and may put themselves or their loved ones in dangerous situations due to intoxication.
People managing to function while struggling with AUD are more common than most assume. A 2007 report from the National Institutes of Health (NIH) found that 20 percent of people struggling with AUD have stable employment, families, and a high level of education; however, some other studies suggest as many as half of all people struggling with AUD could be considered high-functioning alcoholics, at least for a time. Their alcohol addiction will likely progress until they harm themselves, their career, and their closest relationships.
Symptoms Associated with High-Functioning Alcoholism
Signs that a person may meet the criteria to be considered a high-functioning alcoholics include:
- Denial that they have a problem with alcohol because they do not fit the stereotype
- Using their success and stability as proof that they do not have a problem
- Using alcohol as a reward, to relieve stress, or as a justification for completing an important task
- Cravings for more drinks after having just one
- Obsessing about their next opportunity to drink
- Displaying personality or behavioral changes when they become intoxicated
- Continuing to drink too much and experiencing behavioral or psychological changes despite friends or family speaking to them about the issue
- Claiming to not feel hungry and choosing alcohol over meals
- Spending a lot of time and money buying alcohol
- Beginning to choose drinking over situations in which they should remain sober
- Developing a tolerance for alcohol, so they must drink more to feel intoxicated
- Drinking consistently throughout the day, including with all meals and early in the morning
- Experiencing withdrawal symptoms when they are not drinking
When a person displays symptoms of being a high-functioning alcoholic, they will likely be in denial and do what they can to cover up signs that they have a problem. Unfortunately, their friends and family may also deny that their loved one struggles with alcohol, enabling the behavior, making excuses, or hiding signs of the problem. Over time, however, little things will become harder, such as getting up in the morning, overcoming hangovers, feeling normal without alcohol, and saving money.