An estimated 5.3% of the U.S. population, or over 14 million people have an alcohol use disorder. Alcoholism is one of the most common health disorders in the country, as well as the most common cause of preventable death and one of the most common causes of hospitalization. Millions of us struggle with alcohol. And, over 60% of people with an alcohol addiction still have a job.
That might be surprising to hear if you’re accustomed to thinking of alcoholics as homeless, vagrant, and relying on others for subsistence. But, an estimated 19.5% of all alcoholics qualify as “high functioning”.
Learning how to recognize high functioning alcoholism can help you as you determine whether you or a loved one has a problem. That’s important if you’re thinking about getting help. It’s also important if you have to refute a loved one’s using their ability to function as a reason they don’t need help. Millions of Americans have high functioning alcoholism, also known as HFA. They need help just as much as someone without the ability to function while addicted.
High functioning alcoholics might be able to wait till they’re off work to drink. Or they might sneak alcohol throughout the day. Whatever the specific conditions, someone with alcoholism drinks and often a lot. That normally means at least two servings of alcohol per day – but you can have alcoholism and only drink once a week. The difference is in how you approach it.
Of course, some high functioning alcoholics can abstain from alcohol for weeks at a time. Most cannot. Instead, many drink regularly, often even at work. The difference is they drink a small enough amount that they don’t show signs of inebriation.
If you’ve ever had a conversation about minimizing alcohol and then had that completely ignored, you likely have some idea of what this looks like. Most people will occasionally drink a few more than they intend. Alcoholics do this regularly. If every excuse to drink turns into them being blackout drunk, they have a problem. That’s even true if they don’t drink during the week. Anyone who binge drinks to the point of memory loss or blackout every weekend has a medical problem.
Blackouts are memory gaps, where someone might not remember what happened during or after drinking. This starts out by having trouble remembering how you got home. If you drink enough, you’ll have trouble remembering what happened while drinking. When you drink that much, you also have very little control over what you do and say. This can lead to increases in dangerous and reckless behavior, massive increases in quantities of alcohol consumed, and higher risks of alcohol poisoning.
If that sounds familiar, alcoholism should definitely be considered.
If your loved one is pretending they drink less than they do, they have a problem. That also holds true if they hide bottles. Finding alcohol bottles in the trash, in a vehicle, or another spot is never a good sign. In addition, if they drink and refill bottles, they have a problem.
Hiding alcohol use can also go to denying alcohol use to themselves. That normally links to rationalizing it. Here, most high functioning alcoholics look for and find excuses. Normally these look like:
These kinds of excuses are also self-reinforcing. You feel bad so you drink. Then you have a headache because you drank, so you feel bad so, you drink. That also holds true with stress, work performance, and having mental energy to cope with people. So, drinking starts out as a way to reduce the stress or a problem and eventually exacerbates it.
Often, people who drink heavily, attempt to control their behavior when not drinking. That can result in them completely changing their personality when they do drink. They might act more “crazy” or carefree. They might be considerably more reckless. But they will engage in behavior and conversation they wouldn’t have considered when not drinking.
That’s also important, because healthy alcohol use almost never involves dramatic changes to personality or character.
People with alcohol use disorders don’t pay attention to consequences. Instead, they’ll often acknowledge them, maybe try to fix them, and then go right back to drinking. They will drink when they have to drive in the morning. They will drink before driving. Or at work. They’ll spend money you don’t have. And, this kind of behavior just gets worse over time.
That also extends to confrontations and being asked about drinking. Someone without an alcohol use disorder is better able to assess their drinking and talk about it. Alcoholics will avoid it. This avoidance behavior is a survival mechanism. People with substance use disorders use it to sidestep socialized stigma surrounding substance abuse. That may result in them being defensive, angry, or blaming others when their alcohol problem comes up. Mostly, it means that they may not acknowledge the extent of their problem or even that they have a problem.
“Oh come on. I don’t drink THAT much”.
“Have you seen how much Jenna drank? I didn’t even drink half”
“I only have a one drink. ONE DRINK. When I come home from work to unwind. You can’t ask me to give that up”
“Look who’s talking”
If that sounds familiar, alcoholism is a likely culprit.
While high functioning alcoholics have many different traits, they all have one thing in common. They cannot quit. They might try. They might event succeed for a few weeks or even months. But, they always relapse. That’s because they are mentally as well as physically addicted. Physical alcohol dependence is difficult to get over. It normally involves 3-14 days of sweating, tremors, and anxiety. But you’ll face cravings, behavior, and mental health problems for years afterwards. Asking someone to go “cold turkey” rarely works, because they can power through the physical problems but the mental ones don’t go away. Eventually, those add up to where that person relapses. Without treatment, that will not go away.
Many people turn the other way when someone has a high functioning alcohol use disorder. After all, if they’re still getting everything done, who cares. But, high functioning alcohol use disorder is still detrimental to the people drinking, to their families, and to others. For example, there are over 10,000 alcohol-related car accidents each year. Alcohol results in 18% of all car accidents. Alcohol is one of the major causes of early death and of hospitalization. And, alcohol increases risk-taking behavior, domestic abuse, and even self-harm and suicidal ideation. That’s without considering that 20% of high functioning alcoholics can be diagnosed with a mental health disorder. Getting help means going to alcohol rehab, getting help with detox, and using behavioral therapy to help treat the root of the disorder. That means assessing underlying behaviors, building skills and behaviors to help you live a happy life without alcohol, and building the skills to cope with stress and negative emotions in a healthy way.
If you or a loved one is struggling, there is help. And, just because you’re high functioning doesn’t mean you need help less than any other alcoholic.
If you have any questions about high functioning alcoholics or about alcohol rehab programs, contact us today to speak in complete confidence with one of our experienced and caring addiction treatment team.