Everyone thinks they know what alcoholism looks like: the homeless person sitting along a building with a bottle of whiskey or the person who can’t keep a job and yells at their kids continually with a beer in hand. Mass media has propagated certain stereotypes of what alcoholism looks like. This has caused confusion when it comes to high-functioning alcoholism, making it more difficult for individuals, families and professionals to determine exactly when someone has crossed the line into a drinking problem.
The definition of alcoholism includes excessive and inappropriate use of alcohol, but exactly where the line should be drawn is a matter that divides professionals and those who are wondering if their weekend drinking binge may mean something a little more. With claims that a bit of red wine or alcohol may be good for your health, this can make the line even more uncertain.
The National Institute on Alcohol Abuse and Alcoholism considers the definition of alcoholism to be “problem drinking that becomes severe.” There are two problems with this definition: When is it considered problem drinking and when does it become severe? Let’s look a little further at some other definitions of alcoholism and problem drinking.
The standard used by psychologists to determine if a person should be classified with alcohol use disorder is the Diagnostic and Statistical Manual of Mental Disorders. This manual is updated regularly as new research becomes available and integrated. It may be noted that in the most recent update, the DSM-5 changed the definition for alcohol use disorder to combine the old definitions of alcohol dependence and alcohol abuse. The person must meet two or more of the following 11 criteria to be diagnosed with alcohol use disorder. You may be abusing alcohol if you:
- Sometimes end up drinking more or longer than you first intended
- Have tried to cut back but found you couldn’t
- Spend considerable time sick or getting over the after-effects of drinking
- Have wanted to drink so badly that it occupied all of your thoughts
- Find that drinking or being sick from it affects the ability to take care of your family or causes job or school problems
- Continue to drink despite these problems
- Have given up other activities you used to enjoy so that you could drink
- Perform dangerous activities such as driving, swimming, using machinery, having unsafe sex or walking in a dangerous area during or after drinking
- Continue to drink even though it makes you feel depressed or anxious, causes memory loss or blackouts, or adds to other health problems
- Have to drink more than you once did to get the same effect
- Have had withdrawal symptoms when the effects of alcohol were wearing off including restlessness, nausea, sweating, racing heart, shakiness, a feeling that things were not real, or a seizure
These criteria are a bit more useful because they define what alcohol-related problems look like. One thing the DSM does not do is base criteria on how many drinks you have or how often you drink. This is where the term high-functioning alcoholism comes into play.
High-Functioning Alcoholism Has Many Faces
If you looked at this list and suddenly realized that you or a loved one meets two or more criteria, you should continue reading. There are two types of alcoholism that are classed in terms of severity. The severity is based on the impact on your life or the lives of those around you. Those who struggle with maintaining the activities of daily living, such as holding down a job or preserving family relationships, exhibit the more obvious forms of alcohol use disorder.
High-functioning alcoholism may be more difficult to detect. High-functioning alcoholics can often hold down a job and maintain their households. They may effectively hide their weekend drinking problems and signs of abuse from others in the outside world. Some of them become so adept at hiding their issues that family members may not even be aware of them. There are also cases where the family is aware but continues to pretend that they do not know. The alcohol-dependent individual may not know that their family knows their secret.
High-functioning alcoholism has many faces. All classes and races of people may find themselves in its clutches. Just because a high-functioning alcoholic appears to be okay on the outside, it does not mean that they are okay on the inside by any means. Even though the alcohol use may not appear to affect the family, it still causes significant psychological and emotional damage in loved ones and children. The family can appear to be a functioning family unit when attending activities such as school functions, church services or other events in life, but behind closed doors, it can be a different story.
Heading for a Crash
The problem with a high-functioning alcoholic is that they may excel in their career and appear to have good relationships and a host of friends in their circle. They may think that they have their drinking problem under control based on their social and personal achievements. However, it will eventually catch up with them, and they will no longer be able to hide it.
High-functioning alcoholics are often in deep denial about their weekend drinking problem. They can point to all of their successes and be able to convince friends and loved ones to believe them. In the worst-case scenario, family and close friends will cover up for the consequences of their drinking. They unintentionally become an enabler or a codependent. This only encourages the person to continue and escalate their weekend drinking until it becomes more problematic.
The problem with becoming an enabler or codependent is that it will encourage the person to continue down the road to a more severe problem with alcohol. Many times, loved ones will sacrifice their own needs so that everything can appear to be normal at home. This is especially the case when there are children in the home. For instance, when the person with alcohol use disorder misses a child’s school play, the partner may lie and say the other spouse is home sick with the flu. They may make excuses for the person’s poor behavior and try to justify it to others.
Another form of codependent behavior is cleaning up the mess that the alcohol made before anyone can see. They may wash clothing to hide soiled articles quickly. An enabler may also try to cover up the expenses caused by the drinker’s actions such as legal fees, traffic tickets, fines or excessive credit card spending. They may eventually deny their own needs and pretend that they are not hurt by the alcoholic’s behaviors. They may also engage in passive-aggressive behavior to try to change the alcoholic, but this typically only makes the problem worse.
The problem with being an enabler or codependent it is that it can be conscious or unconscious. The person may not be aware that they are engaging in this activity. Before long, the person’s behavior with alcohol use disorder becomes the normal way of living. The spouse may find themselves in a situation where they will go to any length to avoid the potential consequences of confronting the alcoholic or dissolving the relationship. Eventually, the problems will only get worse, and the toll on the family members and friends will become even more out of control. This is true even if the person with alcohol use disorder is always able to give the appearance of functioning in society. Appearances can become very deceiving for all parties involved, and keeping the secret hidden becomes more difficult.
Recognizing the Signs of Alcohol Abuse
If you recognize any of the signs of abuse in yourself or a loved one, it is time to break the cycle. By continuing to live with a high-functioning alcoholic, you are placing your own health in jeopardy as well as your loved one’s health and well-being. The most difficult part of breaking the cycle is confronting the person who has signs of alcohol abuse and getting them to realize how much alcohol consumption is harming themselves and you.
Many times, high-functioning alcoholics will refuse to seek help and may even turn it around and blame you for their problems. Sometimes, an enabler or codependent may be reluctant to confront the alcoholic about the problem because they fear retaliation or negative consequences from the person. These are all very real fears, and if either of these situations crosses your mind, it may be one of the signs of abuse that indicates it may be time to call for help.
One way to break the cycle is to enlist the help of a professional who can stand beside you and let the high-functioning alcoholic know how their drinking has harmed you and the family as well as themselves. This intervention is not designed to make the person feel ashamed for the effect that they have had on the family. It is meant to offer solutions to help them break the cycle. During an intervention, the person is presented with a plan for recovery, but they will also be made aware of the consequences if they refuse to seek treatment. The biggest challenge for caregivers may be convincing the person to attend this meeting in the first place.
Confronting a loved one who is involved in the fallacies that go along with high-functioning alcoholism can be frightening. If you recognize the signs of abuse in your loved one, one of the most important steps that you can take for yourself and them is to reach out for help. An intervention can take many different forms, but it will not happen unless you take the first step. The person will not likely get better on their own, and the problems will get worse over time, no matter how many promises the person makes or how insistent they are about their ability to handle it.
If you do not feel like seeking an alcohol counselor right away, you can talk to a spiritual leader, family therapist or personal therapist to help you get started and cope with the situation. These types of people are there to offer support throughout the entire process.
It is important to understand that a person in need of alcohol treatment may become defensive or even abusive when faced with the information that someone feels they are in need of treatment. An experienced intervention specialist can help you prepare for these reactions and have a strategy to respond effectively. The most important factor is that you seek help and do not try to do it on your own.
Recognizing the signs of abuse and that the weekend drinking in you or a loved one is high-functioning alcoholism is a difficult reality to face. However, if left untreated, these behaviors can eventually lead to full-blown nonfunctioning alcoholism. Even though it may seem mild now, as the person needs more alcohol to satisfy their craving, the problem will progress until it all comes crashing down around everyone. Living with high-functioning alcoholism can be just as devastating as living with someone whose alcohol use has progressed to nonfunctioning. If you recognize the signs in you or a loved one, it’s important to realize that you are not alone; you have a support system to help you navigate these difficult waters.