High- Functioning, but Still Alcoholics

Personal Health
By JANE E. BRODY
Published: May 4, 2009
Sarah Allen Benton is hardly your stereotypical alcoholic. She has a master of science degree from Northeastern University and is a licensed mental health counselor at Emmanuel College in Boston. In recovery from alcoholism for the last five years, she has written an enlightening new book about people like herself, “Understanding the High-Functioning Alcoholic” (Praeger Publishers).
Yarek Waszul
Dr. Mark L. Willenbring, director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism clinical professor of psychiatry at George Washington University School of Medicine, joins the Consults blog to answer readers’ questions about alcoholism.
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As Ms. Benton describes them, high-functioning alcoholics are able to maintain respectable, even high-profile lives, usually with a home, family, job and friends. That balancing act continues until something dreadful happens that reveals the truth – to themselves or to others – and forces the person to enter a treatment program or lose everything that means anything.
A Hidden Problem
Typical high-functioning alcoholics, or H.F.A.’s as Ms. Benton calls them, are in denial about their abuse of alcohol. Coworkers, relatives and friends often enable the abusive behavior to continue by refusing to acknowledge and confront it.
“The story of the H.F.A. is seldom told,” Ms. Benton writes, “for it is not one of obvious tragedy, but that of silent suffering.”
Based on surveys and professional experience, she estimates that as many as half of all alcoholics are high-functioning types. The abuse can go on for decades until and unless some alcohol-related crisis occurs, like being arrested for drunken driving, exposed for having made unwanted sexual advances or being asked for a divorce when their spouses can no longer tolerate the abusive drinking.
Or, like Ms. Benton, they may seek help after recognizing that no matter what they try, they are unable to drink normally and fear that sooner or later their luck will run out.
Many well-known people have publicly acknowledged their battles with alcohol and entered recovery before their lives were destroyed. Among those listed by Ms. Benton are Betty Ford, the astronaut Buzz Aldrin, the actresses Elizabeth Taylor and Mary Tyler Moore, the actor Robin Williams, the singers Keith Urban and Eric Clapton, the football legend Joe Namath and former President George W. Bush.
But there are millions of others – including dentists and doctors, professors and teachers, lawyers and judges, journalists and authors, firemen and C.E.O.’s of major companies – who work for years while abusing alcohol, sometimes putting their lives, and the lives of others, at great risk. Surgeons have been known to operate with shaking hands, yet colleagues who knew or suspected that alcohol abuse was the cause failed to confront the doctor. Employees who suspect a problem often cover up for their bosses.
Ms. Benton emphasized that people in positions of power are often the hardest to detect and help because they tend not to be closely supervised at work, they are assumed to be able to deal successfully with the pressures of their jobs, their high pay enables them to escape the financial consequences of excessive drinking, and they see drinking as their reward for hard work.
As the writer Pete Hamill said in his memoir, “A Drinking Life,” “If I was able to function, to get the work done, there was no reason to worry about drinking. It was part of living, one of the rewards.”
In some cases, the culture of the workplace fosters high-functioning alcoholism. Abusive drinking was once commonplace among journalists, who had “liquid lunches” and frequently met for drinks after work. When work and social lives blend, excessive drinking may be considered part of the job.
Double Lives
A further problem in identifying and getting help for high-functioning alcoholics is that they often do not meet the criteria for alcohol abuse described in the psychiatric diagnostic manual. They have good jobs, perform the expected tasks of daily life and avoid legal problems.
As Dr. Mark L. Willenbring of the National Institute for Alcohol Abuse and Alcoholism put it in Ms. Benton’s book: “People can be dependent and not have abuse problems at all. They’re successful students. They’re good parents, good workers. They watch their weight. They go to the gym. Then they go home and have four martinis or two bottles of wine. Are they alcoholics? You bet.”
As for herself, Ms. Benton said: “Having outside accomplishments led me and others to excuse my drinking and avoid categorizing me as an alcoholic. My success was the mask that disguised the underlying demon and fed my denial.”
Even those who recognize they have an alcohol problem may avoid seeking help because they perceive it as a sign of weakness.
High-functioning alcoholics are highly skilled at leading double lives, Ms. Benton wrote. They appear to the outside world to be managing life well and defy the alcoholic stereotype by being fashionable, physically attractive, even elegant. They also tend to hide their excessive consumption by drinking alone or sneaking alcohol before or after a social event, and disguising or excusing the odor of alcohol on their breath.
High-functioning alcoholics also may not be physically addicted to alcohol, abstaining for days or weeks without suffering withdrawal symptoms. But they are psychologically dependent on alcohol, often focused on when they can drink again and convinced that they need to drink in certain settings. They are also likely to experience blackouts, remembering nothing the next day about a night of heavy drinking, with only a hangover as evidence of their abusive behavior.
“But just because people are high-functioning doesn’t mean they are not putting themselves and others in danger,” Ms. Benton said in an interview. Under the influence of excessive amounts of alcohol, they may operate motor vehicles or dangerous machinery or engage in risky sexual encounters. They may be picked up for driving under the influence, miss important professional or family obligations or repeatedly arrive late to work. And, Ms. Benton said, “They can face the same health risks as a lower-functioning alcoholic.”
Knowing the Signs
In the interview, Ms. Benton listed several characteristics that can help people recognize themselves as high-functioning alcoholics:
They have trouble controlling their intake even after deciding that they will drink no more alcohol than a given amount.
They find themselves thinking obsessively about drinking – when and where and with whom they will drink next.
When they drink, they behave in ways that are uncharacteristic of their sober self.
They experience blackouts, unable to remember what took place during a drinking bout.
“It’s not the number of drinks that defines an alcoholic,” Ms. Benton said. “It’s what happens to you when you’re drinking.”
This is the first of two columns on recognizing abusers of alcohol. Next: A new way to help identify the problem drinker.