The Challenges of Being a High-Functioning Alcoholic

High-functioning alcoholics are individuals who are able to maintain their careers, relationships, and other obligations while displaying signs of alcoholism.  The same is true of high-functioning addicts or individuals who may suffer from high-functioning depression, anxiety or other mental health issues.  Such individuals are able to maintain their day-to-day lives, and in many cases even thrive, yet exhibit symptoms of their respective addiction or mental health disorder.  In each respective case, high-functioning individuals pose a variety of challenges with respect to recognition of a problem, seeking treatment, diagnosis, and recovery.


High-functioning alcoholics are frequently not viewed as alcoholics by their loved ones, by society at large, or even by themselves.  This is because high-functioning alcoholics do not fit the common stereotypes of an alcoholic such as being unemployed or unemployable, smelling like alcohol, slurring their speech, being tardy or absent from obligations, and other such stereotypes that come to mind when one thinks of an alcoholic.  Since high-functioning alcoholics are able to seemingly perform well, their alcohol use does not appear to be problematic.  As such, individuals who are high-functioning alcoholics are often not confronted by their family, friends or by their colleagues in relation to their behaviors surrounding their drinking.  Furthermore, high-functioning alcoholics also lack insight into how or if their alcohol use is causing disruption to their lives.  As such, there is often failure to recognize that their alcohol use is a problem leading to failure to get them help.


In many respects, high-functioning alcoholism can be more dangerous than “regular” alcoholism because it may take much longer for substantial consequences to arise or for the individual to “bottom out.”  This is because not only are high-functioning alcoholics less likely to be confronted about their drinking, but they also have the financial resources to maintain their lifestyle, even in the face of severe consequences.  Alcohol abuse left untreated can be very dangerous, as alcohol addiction tends to be progressive in nature.  This means that over time an individual will build a physiological tolerance to alcohol, resulting in them needing more of the substance over time to produce the same desired effect.  Delay of treatment coupled with progression of alcohol abuse can result in more damage being done over an extended period of time, especially to relationships and their physical and mental health.


Some may ask, “If their lives are not impacted by their alcohol use, then why is their alcohol use a problem?  They are excelling in their careers, taking care of their children, connecting with their spouse, etc.”  The answer is that their lives are always impacted in some way.  While the consequences of their alcohol use may not be so apparent at the time, there is bound to be some area of their life that is indeed being impacted now or that will be impacted in the future.  For example, interior physical damage caused by alcohol to the liver, pancreas, heart, and brain are often left unnoticed until it may be too late.  Or in some way the individual’s relationships with their loved ones may slowly deteriorate over time as they spend more time drinking and less time being present and connecting with others.  The consequences will show up in different ways at different times and in different severities for every individual, but they will show up in some way if the individual’s relationship with alcohol is unhealthy.


Oftentimes once an individual is aware of their own alcohol abuse or a loved one’s alcohol abuse hindsight is 20/20.  In other words, when they look back, they are able to see aspects of their lives which appeared dysfunctional but did not know the cause of it at the time and/or did not know the severity of it at the time.  For example, one may get a DWI/DUI at a time early on in their lives and chalk it up to a mistake of having one too many glasses of wine at dinner and getting behind the wheel of their vehicle.  While we all make mistakes, a DWI/DUI is a red flag that there might be a bigger problem than just a simple bad decision on the surface.  Or maybe an individual spent a night out drinking when they had to be up early the next day for work and woke up hungover and were unable to perform at their optimal potential that day, or perhaps they called off work all-together.  Such incidents may seem innocent if they are an isolated event, but once other consequences arise from one’s alcohol use these isolated events are just another piece of the puzzle that, in retrospect, are clear indications that there was a problem.  Hindsight is always 20/20.


So how and when does one know if they or a loved one has a problem with alcohol.  Before we get there, let’s discuss the word alcoholic.  The term alcoholic is by nature very degrading and stigmatizing.  Although some individuals in recovery find value in admitting that they are an alcoholic, it is something that many find difficulty in coming to terms with.  Suggesting that one is alcoholic is suggestive that one fits into a one-size-fits-all demographic, which stereotypically conjures up images of a low-functioning individual.  The truth is that alcoholism is not a one-size-fits-all epidemic, and it looks different for every individual.  Mental health professionals and addiction clinicians prefer to use the term alcohol abuse than alcoholism.  Clinically, for an individual to be diagnosed with alcohol abuse disorder they must meet certain criteria, or in other words, they must display certain symptoms.  Furthermore, alcohol use disorder is classified by severity as mild (the individual meets 2 or 3 of 11 criteria), moderate (4 or 5 of 11 criteria), or severe (6 or more of 11 criteria).  Furthermore, alcohol abuse may look different for different individuals.  For example, some individuals may be a daily drinker while others may binge drink on weekends.  Both cases can be problematic if the individual displays adverse symptoms.


There is a difference between someone who drinks too much alcohol from time to time and someone who has a clinical diagnosis of alcohol use disorder.  While it is never appropriate to self-diagnose or to diagnose a loved one if you are not a mental health professional, there are certain questions you may ask which may indicate that there is a problem that a professional should look into further.  We often say that if you believe there is a problem, there is likely a problem.  That being said, one of the main indicators is if alcohol is causing adverse effects to any are of your life.  As such, a good question to ask yourself (or a loved one) is, “Is my drinking causing problems in any area of my life?  In my career, relationships, finances, physical health, mental health, sleep, general responsibilities, etc.”  Some other important questions we encourage you to ask yourself are:



Again, it is imperative that you never self-diagnose, however, if you answered yes to any of these questions then your alcohol use is something that you should take a closer look at, and perhaps speak with a mental health professional about.  Furthermore, just because an individual does not meet the criteria for alcohol use disorder does not mean that their alcohol use is not problematic.  Heavy drinking, which is by definition having more than three drinks a day or seven a week for women, and having more than four drinks a day or fourteen a week for men, can lead to significant problems.  Heavy drinking increases the risk for liver disease, pancreatitis, cancers, brain damage, high blood pressure, and cognitive deterioration.  Heavy drinking also increases the chances that an individual will die in a car accident or from a murder or suicide.  Furthermore, heavy drinking also increases the risk of domestic violence, child abuse or neglect, and fetal alcohol syndrome.  There is also an increased risk for mental health issues such as depression and anxiety to develop.


The treatment for high-functioning alcoholics is the same as for all alcoholics, however, they may have unique needs and focus on specific areas in treamtnet.  While executives and other career driven professionals may fair better in an upper scale rehabilitation center where they can relate more with their peers, ultimately treatment will use similar approaches.  Cognitive Behavioral Therapy has been found to be most effective in the treatment of alcohol use disorder, as well as motivational interviewing techniques.  Holistic therapies and behavioral therapies are often implemented to help individuals incorporate healthy habits into their lives such as proper nutrition, exercise, meditation, and other such wellness-based behaviors.  High net-worth individuals who have prominent careers may require or desire more privacy, and therefore seek out a private addiction specialist who can work with them and their families one-on-one for ultimate privacy and confidentiality.  Additionally, mutual help groups such as Alcoholics Anonymous or SMART Recovery can be valuable outlets for support of long-term recovery.


As one can see, alcohol abuse can come in many shapes and sizes, but in all cases can lead to a variety of problems.  High-functioning alcoholism is still alcoholism, and high-functioning alcohol abuse is still alcohol abuse.  Ultimately alcohol affects all individuals the same way regardless of sex, age, race, religion, sexual orientation, or socioeconomic status.  While high-functioning individuals and high-achievers may have a harder time detecting that  a problem exists, there are always red flags and indicators along the way.  In all cases the earlier a problem is detected and dealt with, the easier and faster it will be to treat.  If you or a loved one believe that alcohol is a problem, speak to a mental health professional immediately for support and guidance.


For more information or to inquire about our private concierge therapy services and/or our teletherapy (online therapy/virtual therapy) please contact our undisclosed therapy office location in the Upper East Side of NYC today at (929) 220-2912.


Lin Sternlicht & Aaron Sternlicht

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