It is widely understood in the treatment field that addiction is a chronic brain disease, but it takes time for the associated stereotypes and stigma to fade. A common misconception is that all addicts are tragically flawed individuals who can’t hold down a job or support their families.
According to a 2007 study by the National Institute on Alcohol Abuse and Alcoholism, only 9 percent of alcoholics fit this stereotype. A much larger number can be described as “high functioning” – those who maintain successful careers, families and social lives while secretly battling a drug or alcohol problem.
High-functioning alcoholics or addicts see life through a slightly different lens than other addicts. Here are a few of the rationalizations that allow the high-functioning addict to avoid confronting their addiction.
“If I can maintain my job and family, I don’t have a problem.”
Continuing to drink or use drugs in spite of negative consequences is one of the telltale signs of addiction. But because of their comfortable salary, social connections, position of power and sheer luck, many high-functioning addicts have escaped the consequences that befall other addicts. They aren’t losing their jobs or being threatened with divorce. They keep their professional lives separate from their family lives, and both are protected from their drinking or drug use.
As a result of their outward successes and lack of tangible losses, functional addicts may truly believe they do not have a drug or alcohol problem. Still, in their quietest moments, they may worry about the fact that they can’t control their drug use, think obsessively about their next drink or high, and suffer blackouts, hangovers or other health complications due to their drug use.
“Other people around me drink/use just as much, if not more, than me.”
It is common for high-functioning addicts to surround themselves with people who drink or use drugs heavily. Associating with like-minded drug users allows them to feel “normal” and remain in denial. For some professionals, particularly lawyers, journalists and Wall Street businessmen, a workplace environment that condones overindulgence lets them justify their drinking or drug use as being “part of the job.”
“I don’t drink/use enough to be an addict.”
Some high-functioning addicts do not drink or use drugs every day and manage to get through the morning and/or workday without their drug of choice. Instead, they may go on binges or consume heavily at night and on weekends. Because they exert some level of restraint, they maintain the illusion that they are in control.
But addiction isn’t defined by the number of drinks or amount of drugs used, or how often the drug use occurs. It’s what happens while under the influence. High-functioning addicts may go beyond their limits, drink to the point of blacking out or obsessively plan their next opportunity to use.
“I work hard, I deserve to have some fun.”
“Work hard, play hard” is a favorite motto among high-functioning addicts. Just as others celebrate their accomplishments with a special meal or a shopping spree, high-functioning addicts may use drugs and alcohol as a reward for a job well done. They justify this reward by telling themselves that their drug use affects themselves and no one else.
“I’m not an alcoholic if I drink expensive wine or liquor.”
Many addicts use whatever drug is at their disposal in order to get high; for example, a prescription painkiller addict may use heroin if they can’t access their drug of choice. Some high-functioning addicts consider themselves “above” addiction because they only drink the finest wines or liquors and won’t settle for less.
“I don’t have time for drug rehab.”
Even if a high-functioning addict acknowledges that they have a drug or alcohol problem, they will likely put off treatment until they’ve lost everything. If they hold a prominent position at work, such as a CEO, doctor or lawyer, they may argue that they have too many responsibilities to take time off for drug rehab. As intelligent, successful individuals, high-functioning addicts may also feel that they can solve their own problems, or that seeking help is a sign of weakness which could sabotage their professional reputation.
A Secret Shame
For all of their differences, high-functioning addicts also have a lot in common with other addicts. Despite appearing to have it all, functional addicts suffer the same internal shame that plagues most addicts. There are decisions and behaviors they aren’t proud of and lies that fuel their loneliness, along with the burden of maintaining a double life.
Like other addicts, high-functioning addicts pose a
significant danger to themselves and others. Whether the consequences set in gradually over many years or suddenly as the result of a drunk driving arrest, health scare or loss of a job or relationship, it is only a matter of time until life becomes unmanageable.
Not everyone hits, or needs to hit, rock bottom before getting help. Because it may take decades for a high-functioning addict to feel the full weight of their disease, it is even more critical for family and friends to intervene. Just as someone with diabetes or heart disease seeks out treatment early on and continues fighting the disease as long as it takes to get well, high-functioning addicts need support as they bring their secret addictions out into the open and get the treatment they need to achieve new levels of success.
David Sack, M.D., is board certified in addiction psychiatry and addiction medicine. Dr. Sack is CEO of Elements Behavioral health, a network of drug rehab and addiction treatment programs that includes Promises Treatment Centers, The Ranch, The Recovery Place, and The Sexual Recovery Institute. You can follow Dr. Sack on Twitter at http://www.twitter.com/drdavidsack.