Addiction is often defined as the compulsive use of drugs or alcohol or the continuance of certain behaviors despite negative consequences. These negative consequences frequently take some time to emerge. This, in turn, has led to the idea that in some cases the worst consequences of a substance use disorder can be successfully contained or avoided altogether.
In such cases, the addict is said to be “high-functioning.” The concept was prominently endorsed in a 2007 study by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is part of the National Institutes of Health.
The study described five distinct subtypes of alcoholism, one of which was the “functional” subtype, said to comprise about one-fifth of American alcoholics. The NIAAA described this category as “typically middle-aged, well-educated, with stable jobs and families. About one-third have a multigenerational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50 percent were smokers.”
The character played by Denzel Washington in the movie Flight is a good example. Despite drinking and using cocaine, the pilot, Whip Whitaker, is able to land a plane in an emergency situation, saving all the passengers.
Whitaker is convinced he can control his alcohol and drug use enough that it will not have a negative impact on his work. Another example is television journalist Elizabeth Vargas, who described in her memoir Between Breaths how she was seemingly able to function in her job at a high level for years despite her continued alcohol misuse.
Both Elizabeth Vargas and the fictional Captain Whitaker tricked themselves into believing that they were in control of their disease. But substance use while “high-functioning” is only the initial phase of the disease of addiction. The substance user is living on borrowed time with potentially disastrous consequences. Since they don’t recognize the problem, they will not seek help early enough.
Vargas recounts how she was an effective and dedicated journalist by all outward appearances, but, in reality, the “very slow and very gradual” slide into “problem drinking” had begun. However, she was in complete denial about her condition at that point. Even in her first rehab, “she clung to the idea that she wasn’t really an alcoholic.”
The “functioning” part is primarily confined to outward appearances because the addict is very skillful at hiding the substance abuse and its impact while denying to themselves and others that there is a problem. Especially in the case of alcohol use, which is not illegal per se, colleagues and family members might sustain this denial by buying into the “high-functioning” narrative. The ability to function to some extent is interpreted as an indication that the condition is not really an addiction requiring intervention.
If a severe substance use disorder develops, important social, occupational, or recreational activities will eventually be compromised because of the compulsive drug or alcohol seeking. Addiction is a progressive disease, and “high-functioning” is not sustainable in the long run. Without treatment the disease will get worse.
Delayed intervention is the greatest danger of the myth of the high-functioning addict. Too many people ignore the symptoms of active addiction for too long until their disease reaches a crisis point. That should be avoided.
“Addiction problems can be mitigated if action is taken early on,” says Robert Walters, Vice President of Intake Services at Lakeview Health. “Don’t wait for an arrest or an overdose! Don’t wait for your loved one to hit bottom. Seek help now.”
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