High Functioning Alcoholics

Jesse | Published on May 20, 2009

His drinking obviously isn’t a problem, he’s getting good grades.  She must be fine, she’s performing well at work.

Too often we assume that people who drink a lot but are still able to excel at school or work must not have a drinking problem.  But this may well be a mistaken, and even dangerous, assumption.

On May 4th, Jane Brody wrote an article in the New York Times addressing the issue of high functioning alcoholics (HFAs).  The problem with HFAs is that although they may be high functioning, they are still alcoholics.  What they have managed to do is figure out a very fine balance.  As long as things are steady and stable they can drink and perform.

But eventually something happens to throw them off their precarious perch, and they spiral down rapidly, often losing family, friends, and jobs in the ensuing crash.

In a way these people are more at risk than low functioning alcoholics because the high functioners are hidden.  Even if they have family or friends who see them drinking large quantities of alcohol those friends tend to keep quiet.  How do you confront someone whose life and work are doing just fine and tell them they have a problem?

Brody describes the work of Sarah Allen Benton, a former HFA who wrote a book called “Understanding the high functioning alcoholic”.  Benton writes that the more powerful the person, the harder it is for others to confront them.  Employees are unlikely to confront a supervisor, nurses and residents are reluctant to accuse a chief surgeon.

Additionally, our culture is one that not only permits excessive drinking, but often celebrates it.  College spring break booze-fests do not end with graduation.  Many young (and not so young) professionals continue to see a long night of drinking as a reward for a day’s hard work.

Many people worry that if they don’t drink they will be seen as an outsider by their group of friends.  And certainly confronting someone about their drinking is never the “cool” thing to do, especially if that person is high functioning.  It is much more fun, and much more accepted, to tell funny stories about how wasted so and so was last night and all of the ridiculous things they did.

Until one day that list of ridiculous things includes driving home drunk and hitting another car or pedestrian.

We all have friends who are HFAs.  We’ve probably all dismissed their drinking for a while because it didn’t seem like it was hurting them.  But it is our obligation as friends to address it if we really care about the person.  They will be high functioning until, suddenly, they aren’t, and then it may be too late.

Benton lists some characteristics that can help distinguish people who are HFAs:
-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.
Benton goes on to say: “It’s not the number of drinks that defines an alcoholic, it’s what happens to you when you’re drinking.”

It’s easy to be a friend when the going is smooth.  The mark of a real friend is being willing to have the hard conversations, and possibly even risk the friendship itself, for the good of the other person.  The question is, will you be there for them when they need it most, even if they don’t know, or won’t acknowledge, that they need you.