Unlike most stereotypes that relate alcoholics with failure in their professional, financial, social, and emotional lives, the high functioning alcoholic does not portray any signs of failure. The high functioning alcoholic is an individual whose abuse of alcohol has not affected these important aspects of human life; they are able to maintain their jobs, social connections, business partnerships, and even emotional partners. High functioning alcoholics are individuals who are able to combine normal life events and responsibilities with alcohol abuse without it compromising their operations and existence. While they are notoriously stubborn about the need for intervention, these alcoholics require specialized treatment and counseling.
Why do HFAs drink in the first place?
High Functioning Alcoholics (HFAs) drink for many reasons, some of which may differ from the motivators of normal alcoholics:
- To enable social interaction with their friends, family, and colleagues. Although alcoholics usually drink in relative solitude or secrecy to mask their affliction, HFAs do not need to mask their consumption because of the fact that it does not incapacitate them professionally or otherwise.
- To mask mental illnesses that may be hindering their social, emotional, or professional lives. Although high-functioning alcoholics do not suffer the devastating effects normal alcoholics suffer after an indulgence, their professional and social performance suffer. Consequently, such HFAs resort to masking the resultant mental illnesses, such as depression and anxiety, using alcohol.
- To meet their body’s affinity for alcohol. Like all alcoholics, HFAs usually become addicted to alcohol making them dependent on the substance.
Common Characteristics of HFAs
High Functioning Alcoholics are often very capable of maintaining their personal and professional lives. To society, they appear to have everything in order and lead successful lives. Their lives are highly compartmentalized and they make concerted efforts to distance themselves from the common stereotypes that often accompany alcoholism.
Normally, alcoholism affects individuals adversely in their personal and professional lives, rendering them failures. However, HFAs avoid these failures altogether. They also tend to be in denial and are not able to admit to being alcoholics even when they clinically classify as such. Such alcoholics depend on the stereotypical assumption that normal alcoholics are failures to justify their claims of not needing an intervention. Some more specific characteristics of HFAs include:
- Alcohol-focused: dining, socializing, celebrating or grieving plans include alcohol consumption
- Change of demeanor: becoming unhappy or easily annoyed during extended periods of time without alcohol, and returning to “normal” after drinking resumes
- Blackouts: not remembering conversations or details surrounding activities in which the person participated
- Drinking to function: drinking in the morning, at lunch and/or prior to potentially stressful situations
- Coping mechanism: resorting to drinking as a way to deal with life’s difficulties
It’s easy to overlook these behaviors when someone is managing to take care of their responsibilities. However, these signs of a high functioning alcoholic signify a problem that needs to be addressed. If proper action is not taken, an alcoholic’s health can severely decline.
Signs and Symptoms of High Functioning Alcoholics
In order to intervene before someone’s health declines, one must be aware of the warning signs of a functioning alcoholic or HFA. The longer he or she denies treatment, the more he/she will display these signs and symptoms:
- HFAs prefer to drink rather than eat: When presented with the chance of feeding while indulging in alcohol, these individuals abstain from the food and stick to drinking. Such habits affect their metabolism and physique.
- Drastic changes in behavior and persona while drinking: HFAs may show a slow but distinct change in behavior and persona while drinking. Calm persons become outgoing and even impulsive and vice versa.
- Inability to have only small amounts of alcohol: HFAs drink too much when presented with the chance and have a hard time controlling when to stop.
- Chronic explanations for drinking: HFAs always have an explanation for their drinking habits and tend to add denial and aggression into the mix to cover up their afflictions.
- Concealment of alcohol: Sometimes HFAs conceal the substance on their bodies in the form of sachets and in hip flasks at home or at work. When unable to do so, these individuals sneak off to engage in fast drinking and return after masking the alcoholic breath.
- Surrounding themselves with those who like to drink: This helps to normalize the excessive behavior or the alcoholic.
- Obsessing over the next drink: They may be counting the hours until the next drink and calculating how much alcohol can be consumed without appearing drunk.
- Finishing others’ drinks: HFAs may get another drink from whoever is closest.
Long-term Effects of Alcohol Abuse
The importance of addiction treatment for high-functioning alcoholics cannot be understated. There are many long-term health effects of continued and excessive alcohol use:
- Brain damage – Excessive alcohol consumption leads to the death of brain cells causing cognitive defects, memory loss, and even mental incapacitation.
- Liver tissue destruction – As an individual abuses alcohol, the liver cell’s metabolic effectiveness is exceeded leading to the destruction of its tissue and a disease called liver cirrhosis. Eventually, the person abusing alcohol may require a liver transplant.
- Pancreatitis – This condition creates metabolic problems and damages surrounding tissue when the pancreas becomes swollen or excessively inflamed.
- Social and emotional problems – These can include social abandonment, injury from accidents and falls, marital and family-based separation, and financial issues.
Myths About the Functioning Alcoholic
There are plenty of myths which obscure a clear and accurate understanding of high-functioning alcoholics. Here are some of the biggest lies that people believe:
- Myth: They don’t have a problem. This myth is common because the person can’t see that their problem exists since all personal or professional obligations are met. However, attempting to manage responsibilities while heavily drinking is not sustainable and will catch up with the person.
- Myth: They cannot be successful. On the contrary, functioning alcoholics can have a family, a job, a large circle of friends, and can be very popular.
- Myth: They have control. Usually, they are well-educated, dedicated workers and highly intelligent. This can convince them that their drinking is under control while in reality, they’ve only been successful in keeping their drinking problem private.
- Myth: They do not show signs of alcoholism. They typically drink in order to become relaxed or confident and often prioritize drinking alone and often. Some functioning alcoholics experience problems with concentration or lapses in memory.
- Myth: No help is required. Some manage to live with their dependency without experiencing major losses. Because of this, they foster a deep denial of their problem, but still go to great lengths to feed and suppress evidence of their addiction. This makes functioning alcoholics often the last type of alcoholic to seek treatment.
How to Talk to and Help a Functioning Alcoholic
When talking to a functioning alcoholic, use of a non-judgmental tone is important because HFAs can be defensive and even aggressive. Talking an HFA down or talking over them only serves to exacerbate their alcoholic tendencies. Approach the individual strategically, especially when they themselves are trying to reduce their consumption in order to create the impression of a supportive party rather than a judge.
Never approach or talk to an HFA while they are drunk or consuming alcohol heavily because this may compromise the approach. Similarly, raising your voice or using aggressive gestures, such as pointing, may induce aggression or deflective behavior in the HFA. Avoid confronting the HFA when they are with drinking buddies or other enablers. Such communication dynamics compromise the process of getting through to the individual because they feel victimized and see a bias.
Sometimes spouses, family members, friends, or colleagues fall into the trap of co-dependency by becoming alcoholics, or enablers, themselves. Avoiding co-dependency is crucial for a successful intervention, rehabilitation, recovery process of the HFA. It can be achieved through:
- Creating and maintaining boundaries: The people assisting the HFA must create and maintain boundaries with the recovering HFA. Such boundaries are an important part of the recovery process and reduce chances of being sucked into the problem.
- Mutual respect throughout the intervention process in order to avoid becoming: In order to avoid becoming someone upon which the HFA is codependent, the people assisting in the intervention process must practice mutual respect with the recovering HFA. Mutual respect enables the assisting parties to fight off the attempts by the recovering HFA to use condescending language on them or trickery using temptations.
- Self-respect and valuing your body: One ingredient of becoming an effective support system member is self-respect. This quality enables the individual to avoid indulging too much in alcohol and other substances, a trait that could potentially expose them to codependency. Additionally, such respect for one’s body encourages the recovering HFA to work harder at recovery.
- Knowing and respecting each other’s limits: An intimate knowledge of one’s limits is key to avoiding codependency because the individual cannot exceed these limits. Such discipline makes an individual integral to the process of rehabilitation and recovery of the HFA.
Conducting an Intervention
For HFAs, most processes of intervention are initiated when the patient suffers an occasional loss such as a DUI, an accident, mugging, or emotional separation. Early intervention is critical in avoiding these incidents and may be useful in avoiding more serious consequences related to their addiction.
Tips for conducting a successful intervention include:
- Use professional alcohol intervention professionals. While most people think of alcoholic intervention process from the perspective of friends, colleagues or family, these may not work for the functioning alcoholic. HFAs portray stronger attributes of denial and even aggression necessitating the use of professional therapist and alcoholic recovery professionals.
- Carry out progressive support processes during, and after, the first intervention. During and after the recovery process, the support system members must accompany the recovering HFA to counseling meetings and monitor their progress. Combined with encouragement and compassionate support, such intervention strategies usually succeed in helping even the worst HFA to recover.
- Encourage residential, inpatient treatment with full-time counselors and therapists. The support system members should accompany the recovering HFA on the first day but should also communicate firmly, and respectively, that the journey is the HFA’s. During the rehabilitation and recovery process, family, friends, and colleagues must liaise with the professional intervention personnel to ensure the recovering HFA succeeds in their rehabilitation.
Treatment for High Functioning Alcoholics
There are many options for treatment for an HFA that may aid in the recovery journey. For some, medication may be used to assist in the detox process, including:
- Naltrexone – this is an opioid receptor antagonist approved by a majority of the global medical boards for alcohol dependency treatment. It also intervenes in reversing the psychosocial complications associated with alcoholism. Scientists believe that this drug works by blocking certain opioid receptors associated with the reinforcement process of alcohol dependence and addiction. While it is a mild medication, its side effects include sedation, nausea, vomiting, and anxiety.
- Disulfiram – the second medication used in the treatment of alcohol abuse, dependence, and addiction. Essentially, it works by inhibiting acetaldehyde dehydrogenase which leads to a buildup of acetaldehyde in the blood causing unpleasant symptoms such as palpitations, nausea, chest pain, and low blood pressure. These side effects discourage recovering alcoholics from drinking. It is an effective medication in the management and treatment of alcohol dependence. Liver function tests must be conducted prior to use.
- Acamprosate – this is the third medication that alcohol dependence centers use in treating alcohol addiction. With heavy use of alcohol, brain neurotransmitters are affected and become accustomed to the chronic presence of alcohol. However, when you remove alcohol intake, the system becomes dysregulated and enters a pathologic hyper excitatory state. Acamprosate helps regulate and normalize this brain activity. The drug, also referred to as calcium homotaurinate, produces mild side effects that include sweating and anxiety.
Along with or in place of medication, there are a variety of therapies and treatments available to successfully treat an HFA.
The Need for Support during Detox, Rehabilitation, and Recovery
HFAs need support at all the stages of their intervention. They need support during detox which is one of the hardest parts of the process of intervention. Since HFAs are usually in a sound financial and mental condition, their relapses can go unnoticed causing them to revert back to addiction more easily. They must be watched more carefully and encouraged to participate in the intervention to minimize how much the HFA’s addiction affects his/her family and friends.
HFAs need support during rehabilitation because of the propensity for denial and even aggression. Unlike normal alcoholics who may be subdued from their losses and failures of their over-indulgence, HFAs function normally while in the society. Therefore, the support system participants must be compassionate and avoid judgmental attitudes that may cause a relapse through pride and denial.
Similarly, during recovery, HFAs must be monitored closely to avoid relapses and other negative outcomes such as depression. A support group may pre-occupy the recovering HFA with activities that exclude alcohol or social establishments. Additionally, the recovering HFA must be encouraged to adopt an alcoholic-free life.