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There have been dozens of movies and television shows that portray an alcoholic as a shambolic caricature of a person who has lost every measure of position or status in life. While that can describe the effect that alcoholism has on certain people, it masks the complexity of addiction and how different people are affected in different ways. For some individuals, abuse of alcohol is covered by the veneer of a successful family life, leading many concerned family members to wonder if their loved one is a functioning alcoholic.
To understand what a functional alcoholic is, it is important to understand that addiction is not a straightforward process, and that everything from mental health and gender to age and a family history of alcoholism can affect how a person responds to the effects of unhealthy drinking habits.
While a number of people might fall apart under the influence of too much alcohol, the National Institute on Alcohol Abuse and Alcoholism estimates that 20 percent of problem drinkers have good educations, earn consistent and decent wages, and have stable families.
That may sound like it’s not too bad of an arrangement – millions of people enjoy a drink and can hold down responsible lives – but the “functioning” part of being a functioning alcoholic is countered by the actual alcoholism. In that, functioning alcoholics share a lot in common with other problem drinkers:
The “evidence” of a normal professional or personal life is what makes functioning alcoholism one of the more insidious forms of the disease, as the drinker will use that as a trump card to not only defend alcohol consumption, but also to justify it. Functional alcoholics may claim that for all the hard work they do and time they invest in their careers and families, they are entitled to drink without criticism or question. They may further use that against their loved ones who bring the topic up, judging or verbally abusing them for suggesting that the drinking was getting out of hand – when, “obviously,” it can’t be.
It could also be the case that some functioning alcoholics are truly unaware that their drinking has reached problematic levels, so effective are they the juggling act of living their lives and carrying out their responsibilities, while still unwittingly feeding their addiction.
Psych Central cautions that the more severe the addiction, the stronger the denial. Those who not only deny that their drinking has become problematic, but refute it with vehemence and anger, might be instinctively and compulsively protecting their addiction more than their reputation.
This sense of denial may be seen even if functioning alcoholics realize that something is wrong. Functional alcoholics may feel ashamed by what their loved ones have told them about their drinking habits, but the idea of seeking professional help can seem overwhelming or prohibitive. That fear may be motivated, in part, by the addiction itself, desperately trying to survive by pointing out every reason not to engage in treatment: rehab is expensive; only losers and quitters get help; imagine the social and familial shame if word got out that the chief breadwinner of the house had to go into rehab; substance abuse therapy is difficult, unpleasant, and requires a lot of time away from the house, work and the family; and the prospect of never being able to enjoy a drink ever again.
But the danger with high-functioning alcoholism is that people can get so carried away by their seeming invulnerability (balancing personal and professional obligations while drinking like a fish) that it could take a potentially devastating consequence of drinking for the veil to be lifted from their eyes. Sometimes, this could be as simple as a routine medical check revealing an abnormal liver; at worst, it could be a drunk driving charge (because naturally, high-functioning alcoholics rarely think they are too drunk to drive).
Psychology Today lists some other ways that high-functioning alcoholics might be convinced that their drinking has gotten out of hand, including being given an ultimatum by a boss or spouse, noticing that academic or professional performance has slipped, or being faced with a lengthy (or hefty) criminal penalty for crimes committed while under the influence.
Such measures may be drastic enough to convince the person that, no matter how well things seem to be going, one more mistake made as a result of drinking will end everything.
Even though functioning alcoholics may appear to have their lives together, their compulsion to drink suggests a deeper imbalance. Quoting NIAAA, Everyday Health warns that around 25 percent of functioning alcoholics have had a case of major depression at some point in their lives. While depression is one of the many factors that can contribute to the development of an alcoholism problem, the assistant unit chief of psychiatry at a hospital in Glen Oaks, New York, explains that functioning alcoholics do not realize that their need to drink is motivated by unresolved feelings of depression or anxiety. Psychology Today recounts the case of a 24-year-old high-functioning alcoholic who drank to counter feelings of low self-esteem and anxiety, even as her life appeared normal and healthy on the surface. For her, the end came when she realized that no matter how much she wanted to stop drinking, she couldn’t, and she hated herself for it.
Of course, for all the functioning they do, functioning alcoholics also drink to a dangerous degree. WebMD explains that women who consume more than three alcoholic beverages a day are placing themselves at extreme risk for developing a dependence on alcohol. Due to differences in biology, men (whose bodies retain less fat and more water than women do) can drink as many as four drinks per day before they would be considered heavy drinkers. If these habits describe the drinking patterns of your loved one, even as this person is able to hold down a job and meet familial responsibilities, then there is a strong possibility that this person is a functioning alcoholic.
Other signs to watch out for include your loved one’s inability to adhere to a reduced drinking plan. The person may promise to drink less, as part of a compromise to defer long-term treatment, but such a method doesn’t really address the deeper addiction issues. In fact, the longer the person goes without alcohol, the worse the person’s moods get, and the stronger the desire to resume drinking gets. A promise to drink only on the weekends soon becomes drinking on Mondays and Fridays (and the weekend), and eventually old drinking habits are back, perhaps even worse than before.
In a similar way that some high-functioning alcoholics angrily reject the notion that their drinking is out of hand, some are flippant about it, possibly even joking that they have a problem. However they react, any attempt to defray concern (instead of discussing it reasonably and seriously) suggests that this is a topic they do not want to address in any depth, for fear that it will hit too close to home.
While many couples enjoy having a drink together, alcoholic partners may arrange their schedules to give them time to drink by themselves. They may try to hide evidence of this (paying for drinks with cash or visiting bars or restaurants outside town), and they may lie or try to blame other factors if they are found out.
For all these reasons, approaching a high-functioning alcoholic about the problem is not easy. It is best done when your loved one is not drunk. Psychology Today suggests talking to functional alcoholics when they are hungover or feeling guilty about something they did or said during one of their drunken moments, as they are more likely to agree that their drinking has gotten out of hand when they are in such a state.
To best have that conversation, tell your loved one of the negative effects the drinking is having on you, your relationship, and how family members and friends are also suffering the consequences. Frame that perspective in terms of the emotional, financial, and mental losses that have been suffered as a result of the insistence on drinking. It will be easier for your loved one to see that side of the story when hungover or feeling down about drinking, and this might motivate your loved one to turn things around.
Motivation is a very important concept when talking to an alcoholic (functioning or otherwise).
Attacking or condemning the person for drinking may cause anger, defensiveness, or depression, all three of which provide justifications to continue drinking (even surreptitiously).
Instead, use compassion. This provides the person with an opportunity to step up and have investment in recovery.
Unfortunately, not every (functioning) alcoholic will respond well to such overtures, and even trying to provide encouragement through a low moment will not have any short- or long-term success. If the functioning alcoholic in your life refuses to get help, you should set clear, feasible boundaries for the kind of behavior you will not tolerate, for the sake of yourself or any other people who would be affected by the continued alcoholism. This may entail terminating the relationship, and the situation may actually come to that. If your loved one is a functional alcoholic, that drastic step might be what shakes the person out of the stupor, and motivates the first step toward getting clean.