April Blog:
High-Functioning Alcoholism – A Contradiction in Terms
by Starr Shepard, BPA Health Community Programs Manager
What would it take to change our language around the term “high-functioning alcoholism?” This term is a misnomer because alcohol abuse is by nature dysfunctional.
Approximately 20% of people who are dependent on alcohol fit into the high-functioning sub-type. (Moss HB, Chen CM, Yi HY. Subtypes of alcohol dependence in a nationally representative sample. Drug Alcohol Depend 2007; 91:149-58). Using this term from a clinical perspective can be helpful in understanding which category of alcohol abuse disorder that someone fits into. However, while it’s one thing for an addiction professional to have this definition, what about the person who thinks of themselves as a high-functioning alcoholic? Perhaps they somehow think they’re okay because they think of themselves as “functional.” This can cause people to fall into a deeper state of denial. And functional can turn into non-functional quickly.
Alcohol consumption is normalized enough in our society, and people suffering from alcohol use disorder already justify, minimize, and normalize their drinking. The word “functioning” can be a way to rationalize their behavior. The word and the image it invokes can be the crutch the person uses to support their false rationalizations. One reason why it’s hard for people to decide to quit drinking is because of the mixed messages in their minds and feelings. The term “high-functioning alcoholism” is also a mixed message.
It’s easy to come up with ways this term contradicts itself, but what are some alternative terms we can use when working with people suffering from this? Highly-managed alcoholism? This conveys the amount of effort it takes to manage what is effectively a compartmentalized double-life. Moderately-progressed alcoholism? Mid-stage alcoholism? Both of these terms convey the fact that the disease will progress and in fact already has progressed past the early stage. High-bottom alcoholism? Perhaps this term can plant the seed that entering recovery before they hit rock bottom and lose everything will give people more motivation to quit before they lose anything.
After all, hitting bottom isn’t some objectively fixed point. It’s a spectrum and a slippery slope. The concept of “hitting rock bottom” can keep people abusing alcohol longer since they’re not the stereotypical person who has lost everything but the park bench and the paper bag. As long as people keep thinking they’re functioning and not at rock bottom, the longer they’ll continue on their downward spiral. It's hard enough to break out of the grip of addiction, but with accurate framing and language, perhaps someone will be led to begin their steps to recovery that much sooner.
PC-283-04-05-2021
