MaidenNZ

What is a High-Functioning Alcoholic?
Published on January 21, 2009 by Sarah Allen Benton, M.S., L.M.H.C.

Alcoholics have poor attendance at work. Alcoholics drink every day. Alcoholics are mostly old men. Alcoholics are usually homeless. Alcoholics are unable to do well in their careers. Alcoholics always drink in the morning.

These are just a few of the stereotypes about alcoholics which are pervasive throughout society. These stereotypes increase denial and prevent many alcoholics from getting proper diagnosis and treatment. High-functioning alcoholics (HFAs) defy these stereotype and often go undetected because they do not fit the image of the "typical" alcoholic. The term "high-functioning alcoholic" is one that most people seem to understand or identify with, but ironically it has yet to be formally defined or examined. A landmark study in 2007 by the National Institute on Alcohol Abuse and Alcoholism categorized alcoholics into 5 subtypes: 20% are the "functional" subtype, 32% are the "young adult" subtype, 21% are the "young antisocial" subtype, 19% are intermediate familial subtype (middle-aged with mental illness), and only 9% are of the "chronic severe" subtype, fitting the stereotype of the low-bottom alcoholic. Other addiction experts estimate that between 75% and 90% of alcoholics are high-functioning
An HFA is an alcoholic who is able to maintain his or her outside life, such as a job, home, family, and friendships, all while drinking alcoholically. HFAs have the same disease as the stereotypical "skid-row" alcoholic, but it manifests or progresses differently. Many are not viewed by society as being alcoholic, because they have functioned, succeeded and/or over-achieved throughout their lifetimes. These achievements often lead to an increase in personal denial as well as denial from colleagues and loved ones. HFAs are less apt to feel that they need treatment or help for their alcoholism and often slide through the cracks of the health care system, both medically and psychologically, because they are not diagnosed. Sadly, according to the National Epidemiological Survey on Alcohol and Related Conditions only 25% of alcoholics ever receive treatment-indicating a serious problem of denial on a societal level.

HFAs can exhibit various characteristics at different times or phases of their drinking that can be broken down into different categories and include but are not limited to:

Denial:
• have difficulty viewing themselves as alcoholics because they don't fit the stereotypical image
• believe that they are not alcoholics because they are successful
• use alcohol as a reward and/or justify drinking to relieve stress

Professional and Personal Life:
• able to maintain consistent employment and/or gain an education
• well respected for job/academic performance and accomplishments

Interpersonal Relationships:
• sustain friendships and family relations
• have romantic relationships

Drinking Habits:
• one alcoholic drink sets off a craving
• obsess about the next drinking opportunity
• display personality changes and/or compromise morals when intoxicated
• repeat unwanted drinking patterns and behaviors

"Double Life":
• appear to the outside world to be managing life well
• skilled at living a compartmentalized life (separating their professional and drinking lives)
• appearances contradict the alcoholic stereotype

Hitting Bottom:
• experience few tangible losses and consequences from their drinking, often by sheer luck
• experience recurrent thoughts that because they have not "lost everything," they have not hit bottom

My understanding of HFAs is also from a personal perspective-I have been in recovery from alcoholism for almost 5 years. I too struggled to see that I could be accomplished academically and then professionally while drinking alcoholically. My image of the alcoholic was always an individual who could not hold his or her life together, and I certainly did not fit that description. The denial that I experienced was so deeply rooted and was reinforced not only from my loved ones but from society as a whole.

Alcoholism is a chronic, progressive and lifelong disease that needs to be treated whether the alcoholic is a lawyer or a homeless person. The face of the alcoholic needs to be changed and the walls of denial must be broken down in order that alcoholics everywhere can receive proper diagnosis and treatment.

Raider

Thanks for sharing.

CupofJoe

Thanks for sharing this.

It seems to me that "High Functioning Alcoholic" is not really a type but a stage of alcoholism. Some people stay in that stage for a short time, some for a longer time, some might quit before they progress too far.

In my own experience, I was a "High Functioning Alcoholic" for long time, until gradually I wasn't. The descent wasn't immediately apparent, but by the end of my drinking I was definitely not functioning and getting worse. I identify much more with the stereotype of an alcoholic now (although I'm a woman and not an old man!), although I didn't start out that way.

I thought because I was high functioning for a long time that I didn't need to quit. The key is that alcoholism is progressive and my ego couldn't keep me from turning into someone I no longer recognized...

I do appreciate articles like these, especially if they will help high functioning alcoholics recognize themselves and get help before it gets much worse.

Thanks again.

FBL

I thought I was a "high functioning" alcoholic right up until that day I ended up in the emergency room, questioning my own sanity. Addiction and denial are powerful things, but when we finally break free, the rewards are tremendous and the possibilites are endless.

GracieLou

I feel I was a HFA and that kept me in denial for most of my drinking career. I too looked at the others around me and compared myself away from them. I drank but I was not like them.

When I was running the show I had responsibilities. Even though I moved all those responsibilities around the bottle, I still moved them. That is what I compared myself to. Others did not do this. They did not move these around the bottle, they chose the bottle and so they lost the job, the kids, the car, the house etc. They were alcoholics or they had problems drinking, I did not.

My downfall came when my responsibilities that kept me teetering on the edge for so long were gone. My kids were grown and moved out and I lost that job I had moved around for almost two decades.

The first year was not bad. I was in a relationship so I still had a show to run. Once that ended, it took only took two years for me to slide right off the cliff. When I quit and went to AA I was barely functional.

sugarbear1

HFA is another term for "typical alcoholic"

KateL

I couldn't function at all for years. I suppose it was good in a way because my hangovers were so bad, it was time to stop. I know people who have no bad withdrawals. I used to think they were lucky but now I believe they are unlucky because their bodies are not telling them what they need to hear.

jdooner

I was high functioning based on this definition, however, I left lots of missed opportunities on the table. Alcohol took the '94 Olympics from me as we'll as many other things, so in am not sure how high functioning I was.

I agree it's the stage. I saw the progression and quit when I quit. Perhaps lucky, I knew one day where I was going if I stayed on this train.

I think AA defines this as the type 1 drinker and notes type 1 and 2 are the hardest to stay quit in the wives section. This is because we still have ego and the illusion that we have control. Perhaps this author read the BB as I don't see much new here.

PhaseTwo

I was high functioning through college until the very end I started to be consumed by drinking. If I didn't start the slide into being dysfunctional nothing would've changed. I'm grateful that it happened. I see too many 'functional' alcoholics who think they're fine because there getting their priorities taken care of. They seem like robots going through the motions until they get their reward at the end of the day. It's not really living it's just surviving.

NoJimmy

I fit the OP's profile to a "T", and your description above also applies. The separation between my professional life, family life and the drunk alter ego I unleashed most weekends started to blur. I like that I've just been "me" 24/7 for over a month now. Will take time to figure exactly who that is now that alcohol and weed aren't influencing me.
The fact that I typically only drank on weekends, have a successful career, meaningful relationship, manage my finances well, etc. made it difficult to identify that I had a "problem". That all came crashing down when I completely lost control one night. But in truth, I had been loosing control more frequently, and it was becoming more and more evident to myself and others. Now that I can be honest with myself, much of it was sheer lunacy. It's highly probable I was the only one I was fooling.

EternalQ

Yeah, no one believed I was an alcoholic either. Some still don't.

I say that just goes to show what a horrible double life I was leading.

Alcohol turned me into a liar. And I couldn't be close to anyone cause I had a secret to keep.

So while it looked like not much was affected.... the truth was everything was affected andI was rotting from the inside.

Thanks for this post.

CactusJill

Yep, me too. I binge drank so most people never even saw me drink or saw me intoxicated. I avoided drinking in public like the plague to maintain the image. Like all of you, and as the article describes, I also am a high achiever and have a successful career and never lost a relationship to drinking. My husband doesn't even believe that I have a problem!!

But I too see the progression. Each time I drink I get more angry and violent. It is harder to get up and going the next morning. If I keep going, I will lose it all, of that I have no doubt. For me, the HFA is only a stage. I see bottom and for the first time I am truly afraid.

MaidenNZ

Cactusjill, I totally relate to your post. I was under the illusion that if I didnt drink out in public that somehow I was "in control" and "better" than THOSE alcoholics that my brain couldnt relate to.

I may not have drank in public, but I sure as hell had booze waiting for me at home and I couldnt wait to get there so I could get trashed and reward myself for keeping up the BS act that I was in control.

My low was low, I've lost a lot. I'm scared about my future. I can only work on with a sober mind on the present in the hope I can restore some semblance of what I was

MaidenNZ

In the early stages of my drinking I used to drink in public all the time. Wound up in dangerous situations, could have died several times, drove my car under the influence...really stupid behaviour. After about a decade of this, I started drinking at home. Hiding my behaviour and i some ways that was the worst decision because it all went underground and allowed me to put up this false front.

Who the hell was I trying to fool

CactusJill

I think we were trying to fool ourselves

davaidavai

I always feel reproached by this term. The great and glorious high functioning alcoholic. It just sounds like selection bias to me. I drank and worked and screwed everything up. In fact, I am a lifelong screw up. Meanwhile, the "High Functioning Alcoholic" is well respected at work and at home, is a family man, oh yeah, a real pillar to the community. Well, good for him. I hope the high functioning alcoholic doesn't forget to pat himself on the back as he seeks help and goes back to being a high functioning, high powered earner. You've got it in you, you beautiful highly capable person, high functioning alcoholic!

Enough100

I have 5 degrees, a PHd., have run more than 100 marathons, done more than 50 triathlons,have been married for 30 years, my kids are all college graduates and I am the biggest sneak on the planet. I was able to hide a 1/2 to 3/4 bottle of vodka, per day for almost 20 years. I never missed work (although I went to work hung-over more than once) worked at my church every Sunday, coached my kids school sports for 20+ years, and even drove more than 1000 miles while sipping off a bottle in the car. HFA? No, I am just another drunk trying to stay sober.