A:1. Drinking alcohol before the age of 15
2. Family history of alcoholism
3. Underlying mental health condition(s) (e.g., anxiety, postpartum depression)
4. Trauma history
5. Impulsive personality
A: A high-functioning alcoholic (HFA) is an alcoholic who is able to maintain his or her outside life, such as a job, home, family and friendships, all while drinking alcoholically. HFAs have the same disease as the stereotypical "skid row" alcoholic, but it manifests or progresses differently. Many HFAs are not viewed by society as being alcoholic, because they have succeeded and overachieved throughout their lifetimes. These achievements often lead to an increase in personal denial as well as denial from colleagues and loved ones. HFAs are less apt to feel that they need treatment for their alcoholism and often slide through the cracks of the healthcare system, both medically and psychologically, because they are often not diagnosed.
HFAs can exhibit different drinking patterns and warning signs at various phases of their drinking. Common warning signs include, but are not limited to:
- Experiencing a craving for more alcohol after having one drink, leading to a loss of control over alcohol intake
- Obsessing about alcohol and the next time they can drink
- Not being able to imagine their lives without alcohol
- Feeling shame and remorse from drunken behavior
- Having failed attempts to control drinking
- Surrounding themselves with others who drink heavily
- Compulsively finishing alcoholic drinks—even someone else's
- Being skilled at living a compartmentalized life in terms of separating their drinking lives from their professional/family lives
- Making excuses for their drinking or using alcohol as a reward for their hard work
- Thinking that drinking expensive alcohol or wine implies they are not alcoholic
- Hiding alcohol consumption by sneaking alcohol before a social event or drinking alone
- Drinking despite adverse consequences (either emotional or physical)
- Experiencing blackouts or memory lapses
Loved ones may often experience secondary denial about alcoholic family members, particularly HFAs, by not believing that they are "real" alcoholics or that they do not fit the stereotype of the "typical" alcoholic. However, it is crucial that loved ones and friends express how the alcoholics' drinking negatively affects them. HFAs often need tangible evidence that their drinking is affecting people other than themselves. Any conversation with alcoholic about their drinking should occur when they are not under the influence of alcohol and can often be most effective when they are hungover and possibly feeling guilt or remorse. It is important to express how their drinking is negatively affecting you and how you perceive it is harming others as well (friends, children). In order to prevent alcoholics from getting overly defensive, you can place the emphasis on your feelings and concerns, instead of stating how you think they should be living. You can also dispel some of the myths and stereotypes about alcoholics and explain that individuals can be high-functioning, successful and still alcoholic. It is possible to slowly chip away at their denial, but it is also important to come from a place of concern and not from a position of judgment. Just because you open up about this issue does not mean the alcoholics in your life will immediately get help. However, what you are doing is planting a seed that may encourage these individuals to get help in the future. In some cases, it may be necessary to set limits, boundaries and to pull away if they decide not to pursue help.
If your family members are high-functioning, then they may not be convinced that they are alcoholic. Therefore, you could suggest that they try to control their drinking or to cut back on their drinking. If a person is alcoholic, then they would not be able to permanently adhere to these low-risk drinking goals, therefore providing more evidence that they need professional help. In the case of HFAs, they often need tangible evidence that they are alcoholic in order to penetrate their powerful sense of denial. The National Institute on Alcohol Abuse and Alcoholism has an online program that offers assessment, assistance in cutting back on drinking as well as treatment resources.
Finally, there are professional "interventionists" who are available to assist family and friends of alcoholics in appropriately confronting those individuals, presenting ultimatums, connecting all involved to treatment resources and following up on aftercare with the intention that the alcoholics will ultimately agree to seek help. The Association of Intervention Specialists has a referral network nationwide of board-registered interventionists.
A: Families of alcoholics should also seek support for themselves in order to learn how best to navigate their relationships with the alcoholics, detach emotionally and heal. It can be challenging for families to learn how to find a balance between supporting the individuals without enabling their alcoholism. Al-Anon is a free national mutual-help group for the adult loved ones of alcoholics, Alateen is part of Al-Anon specifically for the teenage loved ones of alcoholics and Adult Children of Alcoholics is a mutual-help group available for adult children of alcoholic parents. In addition, attending individual therapy or even family therapy with an addiction specialist can be effective in gaining understanding about alcoholism and in helping family members cope with their own emotions. Addiction specialists may be located by contacting a physician, current therapist or psychiatrist, health insurance company, local health department or employee assistance program. Some rehab facilities offer family components and weekends programs to help work through issues within the family unit.
A:1. Avoid social isolation
2. Be mindful of "triggers" and avoid them, particularly when you are in early sobriety
3. Try not to spend unnecessary time around alcohol and/or heavy drinkers
4. If you plan to be out socially around alcohol, plan an "exit strategy" so that you are not trapped there if you become triggered
5. Practice self-care (get enough sleep, eat regularly, exercise, etc.)
6. Get appropriate professional treatment for underlying mental illness (e.g., depression, anxiety)
7. Follow through with your treatment plan
8. Be honest with another person if you are having cravings to drink
9. Have phone numbers in your phone of other sober people whom you can reach out to if you are having a hard time
10. Remember that having a craving to drink does not mean you should act on that thought
11. Learn to recognize the "alcoholic" part of your mind, observe it and disregard it
12. Remember that alcohol cravings only last between 30 seconds to three minutes and that they will pass
13. Consider participating in some type of spiritual practice (e.g., meditation, religious service)
14. Get involved and reach out to members of a mutual-help group (e.g., A.A., SMART Recovery, Women for Sobriety)
15. Create a day-to-day routine and structure (e.g., work, making plans)
A: There are many changes that occur when one family member gets sober, and it takes time for a family to adjust even to these types of positive changes. Therefore, it is ideal for you to become educated about alcoholism and the recovery process in order to be prepared for the ups and downs of your loved ones' journeys. It is vital that you take care of yourself so that you will have the emotional energy support your loved ones (e.g., self-care, therapy, Al-Anon, etc.). Working through your own anger, fear, trust issues or resentment toward an alcoholic loved one is imperative if the family unit is going to truly heal.
It can be helpful for you to observe or take part in some aspect of your family members' recoveries, whether it is through family therapy or by attending their mutual-help group "open" meetings (e.g., AA, SMART Recovery, Women for Sobriety) in order to gain a better understanding of their experiences. In addition, you can make an effort to engage in sober activities, particularly during the alcoholic's first year of sobriety. Alcoholics in early sobriety experience changes in every aspect of their lives, and it can be helpful for you to allow these individuals the space to grow, struggle and to find their true selves. Simply asking your loved one how you can be of support to them without compromising your own needs can open the lines of communication and be a symbolic act of caring.
Relapse can be a huge fear and concern of loved ones and often, but certainly not always, a part of the recovery process. Find balance between setting healthy limits to prevent enabling, should this become an issue, and letting your loved ones know that you are not giving up on them can be a difficult but integral part of healing within a family.
A: If alcoholics are willing to seek help, they should receive assessments by addiction specialists or physicians about what level of care they may need. Research indicates that alcoholics benefit from mutual-help groups in addition to individual and group therapy and medication treatments (for those with underlying mental health conditions such as anxiety or depression). There are several mutual-help groups available—including Alcoholics Anonymous —that have support group meetings online and in person throughout the country and internationally. For HFAs in particular, it can be helpful to "shop around" for a meeting in which they feel comfortable and to try not to compare themselves to the lower-functioning alcoholic stories.
For specialized addiction treatment options, alcoholics or their loved ones can contact their physicians, current therapists or psychiatrists, health insurance companies, local health departments or employee assistance programs. However, if they are unable to obtain specialists through those means, they can contact the American Psychological Association (APA) at 800-964-2000, ask for their state's APA phone number and request to find psychologists with addiction specialties. When contacting an insurance company, members should call the "mental health/substance abuse" phone number on their insurance cards, ask for benefit information and then request a list of therapists/psychiatrists who specialize in substance abuse in their local areas.
Some alcoholics may need to go to detox facilities if they are physically dependent on alcohol, and others may need to attend rehab facilities for weeks or months, then attend mutual-help group meetings and outpatient therapy upon discharge. The U.S. Department of Health and Human Services has a national treatment facility locater that can help in finding a local detox or rehab facility. In addition, they can visit the Resources page on HighFunctioningAlcoholic.com for more information or to inquire about specialized care in their areas.
A: The writing process of this book was a healing experience for me, and it helped me to process and conceptualize my alcoholism on a deeper level. I was able to find meaning in the difficulties that I had been through and in knowing that I had the honor of being able to touch the lives of others through my writing.
Once the book was released, I faced many new challenges. For most of my sobriety, I have kept the fact that I am a sober alcoholic private because of the stigma—I feared that in certain areas of my life, people would judge me for being an alcoholic. In some ways, I had led a double life—going to work during the day and then participating in various aspects of recovery in the evenings and on weekends. So now, in sharing my story publicly, I am exposing myself. Although in the past this would have made me feel very vulnerable, I now feel a sense of pride in being sober. It is difficult to think that people may judge or view me differently after reading Understanding the High-Functioning Alcoholic . However, I have chosen to sacrifice my privacy in an effort to chip away at the stigma of alcoholism and to help other HFAs to connect with my story and hopefully pursue treatment.
It is my intention to increase awareness that being successful and being alcoholic are not mutually exclusive, but that HFAs need help regardless of their seeming exterior success. My intention is to help end the denial that so many HFAs and their loved ones have around their alcoholism, because these individuals are able to succeed in so many areas of their lives. Alcoholism does not discriminate, and it is imperative that the public learn that being alcoholic is not determined by how people's lives appears on the outside, but by what happens to those individuals when they drink alcohol. Finally, that I am able to express that HFAs need to get help for their alcoholism just as lower-functioning individuals should—for they all suffer from the same chronic, lifelong and potentially fatal disease.