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:
• 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
• sustain friendships and family relations
• have romantic relationships
• 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
• 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
• 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.
More information on this topic is available in my new book Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights (www.highfunctioningalcoholic.com).