According to National Institute on Alcohol Abuse and Alcoholism, approximately 88,000 people will die annually from alcohol-related causes. It is the “third leading preventable cause of death in the United States” and cost over $223.5 billion annually.1 In 2013, 16.6 million adults over the age of 18 had an Alcohol Use Disorder (AUD) (DSM–IV), while only about 1.3 million or 7.8% received treatment at a specialized facility.1 A growing concern is the High-Functioning Alcoholic (HFA) who goes undetected in the community because they appear to work or operate well in society. But behind closed doors, this individual is struggling with the disease of alcoholism and in need of help.
What is a High-Functioning Alcoholic?
According to the book Understanding the High-Functioning Alcoholic 3 by Sarah Benton, a Licensed Mental Health Counselor, a High-Functioning Alcoholic is defined as “a person who defies the stereotype of the image of the typical alcoholic.”3 They are able to maintain jobs, families, and day to day living with little to no disruption in their normal routine. The High-Functioning Alcoholic typically is in denial about their abuse which in turn makes them less likely to seek treatment.
What is the pattern for drinking?
Whether you are concerned about yourself or another person who may be living as a High-Functioning Alcoholic, the first question you should ask is what the person’s pattern for consuming alcohol is? Men would be considered at high risk or a heavy drinker if they consume more than 4 standard drinks on any day and more than 14 drinks per week. While women who consume more than 3 standard drinks on any day and more than 7 drinks per week would be considered high risk. 4
A “standard” drink is considered to be: 4
- Regular Beer (12 fl oz.) – 5% alcohol
- Malt liquor (8-9 fl oz.) – 7% alcohol
- Glass of Wine (5 fl oz.) – 12% alcohol
- 80 proof alcohol (1.5 fl oz.)- 40% alcohol
Studies show that about 1 in 4 people who drink in excess of these limits already has an Alcohol Use Disorder and that the rest will likely develop a problem over time. However, other factors must be considered when identifying alcohol abuse to include how fast a person drinks, medical conditions, age, BMI, prescribed medications, and how alcohol may affect an individual. Any of these factors can enhance the effects of alcohol on a person which can lead to health and personal problems.
Possible Behavior of the HFA
Detecting a High-Functioning Alcoholic can be difficult because often times there are not any obvious patterns of abuse. However, repeated episodes of abusive behavior may be a sign that someone needs help. Some behavior that may be observed and a cause for concern include:
- Drinks seem to be “unlimited” – They often want “just one more” or will continue to drink after everyone else is done.
- No drink is left behind – Leaving a drink on the table is not an option for a High-Functioning Alcoholic.
- Frequent Blackouts – Often times, the person will not remember certain events that took place or periods of time are lost “even though they did not seem intoxicated at the time” or demonstrate a high tolerance.
- Aggressive Behavior – As the person drinks, you may notice a change in behavior such as aggression or defensiveness if they are questioned about their drinking.
- Denying there is a problem – When a person is questioned about their drinking behavior, the result may be adamant denial that there is a problem. They often feel that since they are able to function so well in society that there is no problem.
- Jokes about his or her drinking
- Misses or is regularly late to appointments or work
- Gets a DUI or is confronted with other legal problems due to alcohol
- Alcohol is used as a tool to relax or build confidence
- Hides their drinking
- Drinks any time during the day including morning or when alone
- Thinks they are in control of their drinking.
- They may drink instead of eating or substitute alcohol for food.
- After a heavy night of drinking, they will regularly wake up without a hangover.
- They may go through periods of abstaining from alcohol which may result in a negative physical reaction such as irritability, nervousness, anxiety, sweating, increased heart rate, and feelings of being uncomfortable.
Risk Factors for Becoming an HFA
Anyone can develop into a High-Functioning Alcoholic. Among some of the factors that may put a person at higher risk includes having a family history of alcohol problems, a history of injuries or legal problems that are related to drinking, a person who begins drinking at an early age, may suffer from trauma or a mental health disorder, abuses other substances whether legal or not, a high stress job or a strong peer influence who over consume alcohol.
How to approach an HFA about Treatment
Addressing someone who you suspect has a problem with alcohol or is in denial is not easy. The first step is to consult a professional for personal support to learn about how to approach the person and talk to them about your concerns. The conversation should take place at a time when the person has not been drinking and includes how their behavior has affected the family and those around them. There are many professional interventionists who are trained specifically in talking to someone about this problem and can help navigate the denial and resistance that may arise. The person must be willing to consider they have a problem in order for them to be receptive to getting the help they need or be willing to accept they have caused concern by friends and family.
If you think someone you care about may be dependent on alcohol and is in need of treatment, Casa Palmera can help in their recovery. We offer a medically supervised detox that assists a person who has been drinking heavily over time. A person who suddenly stops drinking on their own can suffer from life-threatening complications. Our trained medical staff will help the patient develop a safe recovery plan that is individualized and best suited for them. Casa Palmera understands that recovery is not an easy process, and we are here to provide the tools needed to be successful so that life can begin again.
Alcohol Facts and Statistics, www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics 1
SAMHSA, http://www.samhsa.gov 2
Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights, Sarah A Benton M.S., LMHC, LPC 3
Rethinking Drinking (NIAAA booklet): Alcohol and Your Health, rethinkingdrinking.niaaa.nih.gov 4