At the bitter depth of Emily's drinking problem, she was married to a successful writer, raising a nine-year-old child and volunteering as a part-time teacher at her daughter's school, all while running the household finances. "We had a million-dollar house, were part of the community, and I believed that as long as my child was well-dressed and doing well and I made it to her little events, I was doing okay," she says. "Never mind that every time I would drop her off at school, I rushed to the liquor store to pick up a fifth of vodka."
Emily is not alone. According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA) 2007 study, 19.5 percent of all alcoholics -- nearly four million people -- are of the "functional" subtype. These high-functioning alcoholics are able to create enough manageability within their home or professional lives that the consequences of their drinking are often too subtle or well hidden for them to experience the turmoil that forces many other alcoholics into submission.
According to Dr. Mark Willenbring, a nationally recognized expert on alcohol abuse and the former director of the NIAAA's division of treatment and recovery research, "Alcoholism isn't what it used to be. We think of it as this really dramatic, debilitating disorder, but actually there is a wide range of alcoholism, from moderate drinking to at-risk drinking. Every alcoholic isn't Mel Gibson or Lindsey Lohan -- people who are really train wrecks. Many high-functioners try to set limits but inevitably they go over them. They want to quit but they can't. They might suffer from hangovers, insomnia or heartburn, but they don't experience the same life-disrupting problems that befall other addicts. So unless they get a real wake-up call, they just end up pursuing the same path."
That doesn't mean that those who've held onto their homes and families are somehow safe. According to Sarah Allen Benton, a mental health counselor at McLean Hospital in Waltham, Massachusetts, "While HFAs may be succeeding professionally or academically, they may also be engaging in dangerous behaviors -- such as drinking and driving, having risky sexual encounters and blacking out." Benton, author of Understanding the High-Functioning Alcoholic, says that high-functioning alcoholics face grave consequences the longer they keep drinking. "Although they may have been able to avoid serious trouble professionally or personally to a certain point, it is only a matter of time before alcoholism will lead to severe problems," she says.
Raised in an upper-middle class neighborhood of Washington, D.C, with the good looks and privileged air of a young Gordon Gecko, Jim, 34, was one of these high-functioning alcoholics. He began drinking and snorting coke while he was an undergrad at an Ivy League college; soon afterwards, he went on to another coveted college to get his MBA.
He graduated with honors and a heroin problem. "I hear people talk about using and being strung out immediately," he says. "I used heroin like a gentleman, sniffing it for years. I didn't shoot up. And because I went to good schools, had good jobs and was
making lots of money, nobody cared until the end."
But as Jim's responsibilities increased, so did his drug use. He started working in a prestigious financial company, and, as he explains, his habits became harder to conceal. "When you're working at a big firm, it's okay not to be around; if I was buying
dope on the street or going shopping -- which I would do while high -- no one would really notice. But then I would get more work and be expected to show up more, and I was so strung out, I just couldn't do it." Indeed, admitting that your life has become unmanageable is difficult when you have money in the bank and everyone in society tells you that you're a success. "Being a junkie was legitimized for me because I was doing well in all other areas of my life," he says. "Still, that was a time when making money was easy and Wall Street jobs were plentiful. I never would have been able to continue getting loaded if things were like they are now."
Dr. Domenic A. Ciraulo, a professor and the Chairman of Psychiatry at Boston University School of Medicine, echoes that belief, saying that the current downturn in the economy helps bring on the consequences of overindulgence more quickly. "I have seen a lot of people who have been laid off, people who have been suffering because of the economy slowing down," he says. "They start drinking a lot, which often means they'll be the first ones to be let go. After a while, they see the money running out and then they realize that they have to do something. It's not until then that they are finally willing to see their alcoholism as a problem."
For Melissa, a 55-year old practicing attorney who dresses like a catalogue model for Brooks Brothers, the biggest challenge to her sobriety was her ego, not the economy. "I was so high-functioning with a good job, a husband and a big house that even if
someone had come and told me I was an alcoholic, I wouldn't have believed them," she says. "I was doing really high-level work for really prestigious firms, and it allowed me to maintain my level of denial because I thought if I can do all of these things -- if my bosses are giving me all this responsibility -- I must be doing fine."
This is common thinking for many high functioning users, especially those who hold jobs that lend themselves particularly well to drinking. According to Ciraulo, "One of the biggest challenges for functioning alcoholics is when they are in a profession that
encourages social drinking, like the legal profession." (Journalists, Wall Street traders, advertising agency employees and those who work in sales are also prone to public drinking.)
Melissa found that when she was finally faced with losing her job and actually attempted to stop drinking, she was powerless over it. "I think it's difficult for any alcoholic that has a certain level of comfort in their lives to see that they need to quit," she says. "It took some time for me to realize that I didn’t have any other excuses or things to point to that were the problem. It was hard to think, 'I need to make a fundamental life change.' Even with a couple of years sober, I can still look around at people with much lower bottoms, and wonder if I really am an alcoholic."
The other issue for HFA's is that they tend to have so many responsibilities that taking 30 days off for treatment can let their secret lives out of a bag in a way that makes them uncomfortable. "I didn't know how I could take the time off to get help, because I was carrying this secret," Emily says. "I needed to detox but how I was going to get out of work, who was going to take care of my daughter, what were my parents going to say? Eventually I just stopped showing up for life, and I realized I was either going to destroy my life, or I was going to have to stop drinking."
According to Willenbring, high-functioning alcoholics "are not getting DUIs, their spouses are not threatening to leave them and they're not losing their jobs. If you ask most people what it would take for them to walk into Betty Ford and Hazelden, they will all say it would have to be the last option they had left. We need to make treatment affordable, attractive and accessible for the HFA, reaching them through the current healthcare system, their family doctor or through their psychiatrists."
Over time, Melissa has come to see how well she functioned before getting clean as a lucky break. As she says, "Do you want to get treatment when you have just gotten cancer or when you're at stage four? I'm really blessed that I managed to got sober
when I did, and not when I had nothing left to lose."
Kristen McGuiness is a freelance writer and regular contributor to The Fix who wrote previously about the 13th step and dreaming about drinking. She is the author of 51/50: The Magical Adventures of a Single Life.
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