If someone you care about seems to be drinking excessively but still manages to get to work or school and do what they need to (for the most part), seems reasonably healthy, shows up for social events and otherwise participates in his or her life, you may be reluctant to broach the subject of alcoholism with him or her. After all, the substance use may not seem to be causing problems — at least not yet. But that doesn’t mean a so-called “high-functioning alcoholic” (or substance abuser) isn’t headed for trouble, cautions Tom Horvath, PhD, a clinical psychologist and owner/president of Practical Recovery, a non-12-step drug rehab and alcohol treatment program in San Diego, California.
With high-functioning alcoholics, “it takes a while for problems to catch up to them,” Dr. Horvath says. Often, “they can mitigate the damage caused by their drinking while still drinking the same amount.” But unless the excessive drinker stops or cuts back on their own, or seeks help, the habit is likely to progress, potentially leading to personal, professional, legal and/or health problems and/or an accident or injury, for example. The first step toward helping your spouse, partner, relative or friend is to recognize the signs of trouble brewing and intervene — before serious harm occurs.
Seeing the Signs
Patterns can vary somewhat, but high-functioning alcoholics often have several symptoms in common. These include an inability to control how much they drink once they start; focusing excessively or obsessing about when they can next drink and who they can go out drinking with; “pre-partying,” or drinking before going to parties or bars, on a regular basis; and/or setting drinking limits — saying that they’re only going to have two drinks, for example, but not being able to adhere to a limit, says Sarah Allen Benton, a therapist in Ridgefield, Connecticut, and author of Understanding the High-Functioning Alcoholic.
In addition, high-functioning alcoholics tend to have an “increasing sense of denial that their heavy drinking is a problem since they are able to succeed professionally and personally,” Benton says. “They also tend to become defensive in conversations about possibly cutting back or stopping drinking.” Part of the underlying problem: They simply can’t imagine their lives without alcohol.
Addressing the Problem
When you’re ready to confront a potential issue with your loved one, start by following Benton’s number-one rule: “Any conversation with a high-functioning alcoholic about his or her drinking should occur when the person is not under the influence,” she says, adding that “it can often be most effective when they are hung-over and possibly feeling guilt or remorse.”
Start by expressing how the person’s drinking is having a negative effect on you and how you also see its harmful impact on your children, friends and/or family members. You might point out how the person’s behavior changes in uncharacteristic ways that are upsetting, or how you worry about his or her safety while drinking. “To prevent a high-functioning alcoholic from getting overly defensive, place the emphasis on your feelings and concerns instead of stating how you think he or she should be living [or behaving],” Benton recommends. “It’s important to come from a place of compassion, not a position of judgment.”
You might remind the person how much you love or care about him or her, and give him or her credit for being so accomplished and capable, adds Horvath. Then, point out that there will eventually be a price to pay, and most likely in a major way, for all the drinking and that you want to help prevent that from happening. It’s important to be patient and realize that you may not make much headway on your first attempts. Don’t expect the person to quit drinking or seek help right away. “What you’re doing is planting a seed that may help this individual to get help in the future,” Benton says. If your loved one is receptive to your concerns and willing to seek help, encourage him or her to be assessed by an addiction specialist (such as a therapist, physician or psychiatrist) to determine the appropriate level of care. In the meantime, it may help to offer to attend an “open” meeting of a mutual-help support group like AA, SMART Recovery® or Women for Sobriety with your loved one, Benton says, to ease their fears and get the recovery process started.