How to Recognize a High-Functioning Alcoholic

They’re often unrecognizable as alcoholics, walking among us, working alongside us, able to carry out (at least superficially) their responsibilities. Perhaps they’re even members of our own families. The high-functioning alcoholic is very adept at concealing their alcoholism – even from themselves. But the signs are there. You just have to look for them.

What is a High-Functioning Alcoholic?

To function is to be capable of carrying out a specific action or activity, to operate or to work. High-functioning alcoholics, then, are those people who are able to convincingly go through their prescribed roles and carry out their duties – yet who continues to drink alcohol. They are able to maintain relationships with family, friends and colleagues, keep up with their job and home. In essence, they lead a double life: they are outwardly the successful, capable husband, wife, sibling, child or other relative, friend, or coworker, while inside they are alcoholics.

High-functioning alcoholics would never put themselves in the same consideration set as a skid-row drunk. In fact, while both have the same disease, with high-functioning alcoholics (HFAs) the progression is quite a bit different. With their extraordinarily high level of denial, they often find it extremely difficult to admit that they even have a problem with alcohol. Through years of success and achievement – despite drinking – the HFA isn’t looked upon by others as an alcoholic.

In addition, due to the stigma and shame still associated with alcoholism, the HFA would be loathe to admit to others, let alone himself, that he has a problem with alcohol. Such personal denial is also accompanied by denial of others. “He can sure handle his liquor,” some might say. Or, “I’ve never seen her drunk,” might be another comment.

Since they won’t or can’t admit that they are alcoholics, HFAs often remain undiagnosed and slip through the cracks of America’s health care system. They also are likely to be the last to seek treatment for the disease.

Warning Signs and Symptoms of HFAs

Although some of the warning signs and symptoms of HFAs are similar to those of other alcoholics, they often appear at different stages of the progression of alcoholism. Some signs may not be present in all HFAs, or may occur in clusters. One thing is certain: the longer the HFA goes without treatment, the more likely he or she will display some of these warning signs and symptoms.

• In the company of others who drink – The HFA surrounds himself with others who like to drink. This assimilation makes it difficult to pick out the HFA as being different from the rest. Besides, the HFA truly enjoys drinking and being around others with similar likes.

• Obsessing over alcohol – The thought of alcohol is never far from the mind of the HFA. Counting hours until the next drink, mentally savoring the mellowness and pleasure of the impending drink, calculating how much alcohol can be consumed without any outward signs of drunkenness – the HFA obsesses over alcohol.

• Consuming craving – One drink is never enough for the HFA. The lure is too strong, and the craving consumes the HFA until he or she can have the next drink – and the next, and the next. Before long, the HFA has lost control over total alcohol intake – even though he or she still may appear outwardly normal and in control. After all, they are masters of discipline and concealment.

• Alcohol is part of their lives – The HFA would no more give up alcohol than they’d give up their identity. Alcohol is so much a part of their lives that they cannot imagine a life without alcohol.

• Finishing drinks of others – If someone the HFA is with leaves a drink on the bar or the table, the HFA may pick it up and finish it. “Don’t want to let this go to waste,” he may say in a joking manner. Related to this is the example of the HFA downing his own drink when it’s time to leave – to go to the table at the restaurant after waiting at the bar, for example – and then quickly ordering another. If a family member or friend doesn’t touch his or her drink, the HFA often drinks it along with his own.

• Experiencing shame over drunken behavior – Being such masters of concealment, the HFA does often experience remorse and/or shame over instances where their behavior has become sloppy after drinking. Such behavior isn’t part of their carefully crafted images and they consequently work even harder to avoid such mistakes in the future. But they won’t quit drinking.
They’ll just watch their behavior more.

• Self-deluding – Some HFAs drink only expensive wine or liquor in the mistaken belief that this means they’re not an alcoholic. It’s a self-delusion that allows them to continue to drink with impunity.

• Fit life into compartments – Another familiar sign of HFAs is that they are able to conveniently separate their drinking lives from the rest of their existence. Who they are at home, on the job, or to casual acquaintances is totally different from their drinking routine and environment.

• Tried to quit but failed – At some point the HFA may have tried to quit drinking but failed in the attempt. This pattern may often be repeated, but still the HFA refuses to seek treatment. It is part of their personality makeup, their self-constructed identity that they feel they can handle their drinking on their own. Such refusal to get help is difficult to overcome.

• Excuses and rewards – HFAs feel they work hard and deserve a drink as a reward. Drinking, to the HFA, is both an excuse and a reward. The HFA may even use those words in defense of his actions – to himself and to others.

• Hiding and sneaking – When others are going to be around – and watching – the HFA may sneak a drink early, drink before going out, or drink alone. Such secrecy is part of the concealment of the HFA’s true problem. He or she has to get in the drinking, but can’t take the risk of others finding out or suspecting the real problem.

• Emotional and physical consequences don’t matter – Whether minor or severe, emotional and physical consequences of drinking don’t make a difference to the HFA – who will continue to drink, regardless. It’s only when things really spiral out of control that the HFA, or those closest to him, may seek help for the problem.

• Blackouts, memory losses, or worse – At the end of the HFA’s downward spiral – just as with any other alcoholic – blackouts, memory losses, increasing physical, emotional, psychological, social and/or legal problems intensify. It’s at this point that the HFA either gets treatment or continues to deteriorate.

Who are HFAs?

Look around you. High-functioning alcoholics are in every profession and walk of life. They’re not all men, either. Alcoholism strikes men and women equally. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), there are more than 2.5 million female alcoholics, and one-third of women report regular consumption of alcohol.

Another pretty frightening statistic (which is borne out in recent stories of fatal automobile crashes) is that there has been a 28.8 percent increase in the number of women arrested for driving under the influence (DUI) in the past decade. Surprisingly, however, there was a 7.5 percent decrease in the number of males arrested for DUI over the same period.

When you consider that many of these millions of female alcoholics are also mothers, you begin to understand the magnitude of the problem – for the female HFAs as well as their families and others. Stigma and shame for HFA mothers keeps many from getting the treatment they so desperately need.

Risk Factors for Becoming an HFA – or Alcoholic

Research studies show several risk factors contribute to a person becoming an alcoholic, HFA or otherwise. These include, but are not limited to, the following:

• Drinking at an early age, such as before the age of 15

• Family history of alcoholism

• Presence of an underlying mental health disorder or condition (such as anxiety, depression, post-partum depression, etc.)

• History of trauma

• Impulsive personality

• Peer influence

• Other substance abuse (including cigarettes, street or prescription drugs)

How to Approach an HFA about Treatment

Family members or concerned others may try to convince the HFA that treatment is necessary, but they first have to overcome the obstinate denial and resistance from the HFA. Remember, the HFA has been able to go through life hiding their alcoholism. It won’t be easy for them to admit that they have a problem, let alone a problem they can’t resolve themselves.

Recognize the signs and symptoms of an HFA in your loved one? If you do, you’ve gotten past your own denial. It’s often very difficult for those closest to the HFA to see the signs of alcoholism – even when they’ve been present for years. Once you do recognize your loved one is an HFA, what should you do?

Addiction experts say it is important – crucial, even – to let the HFA know how much their drinking behavior hurts you, how it negatively affects you and the family. Never approach them when they have been drinking or are suffering from the aftereffects of a bout of drinking. Wait until they are completely sober and, hopefully, have eaten a nourishing meal. It is also important that the conversation is not defensive. Start by stating how you would like things to be in the family, and emphasize your feelings and concerns. Expect the HFA to deny the problem. You could then talk about how people can function at home and at work and still be alcoholics, that they’re called high-functioning alcoholics. Denial may still – and probably will – occur. Be prepared to show tangible evidence of alcohol-related problems. Such documentation is perhaps the only proof that will convince the HFA that there could be an issue with their drinking that needs addressing. Never put yourself or your children or other family members at risk, however. Avoid confrontation and conflict, as this will not solve the problem.

Intervention may be appropriate, as skilled professionals are often able to chip away at the HFA’s denials and resistance and succeed in getting them into treatment.

You will need resources to do this. Check out the assessment tools, tips on cutting back, treatment referrals and services at the NIAAA site. For example, at-risk or heavy drinking involves consumption of more than 4 drinks per day or 14 per week for men and 3 drinks per day or 7 per week for women. Look through the FAQs for answers to common questions about alcoholism. Professional help to quit drinking may involve medications (naltrexone, acamprosate, and topiramate), alcohol counseling (12-step groups, cognitive-behavioral, motivational enhancement, or a combination), or specialized, intensive treatment programs. On the NIAAA site you can also download the 16-page NIAAA booklet Rethinking Drinking: Alcohol and Your Health.

For an interventionist, review referral information from the Association of Intervention Specialists.

Another helpful resource is the National Institute on Drug Abuse (NIDA).

Also check out the highly-recommended book, Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights, by Sarah Allen Benton, a licensed mental health counselor. Also check out her blogs on Psychology Today and her interview and excerpt from the book on Oprah.com.

Bottom line: don’t give up – on the high-functioning alcoholic. But do encourage them to get the necessary help to overcome their problems with alcohol. Set boundaries and insist on open and honest discussion of the HFA’s situation. Be safe, supportive, and persistent.