Unmasking High Functioning Addiction: A Psychiatrist's Perspective

In the world of substance abuse and addiction, appearances are often very deceiving. Many individuals with alcohol and/or substance use disorders manage to maintain their professional and personal lives, earning the label "high functioning addicts." It may take years or even decades for the true devastation of their disease to overcome their ability to function. 

The top psychiatrists at Mental Health and Wellness Associates, are experts in the diagnosis and treatment of both mental health and substance use disorders. Our team knows how to unravel and how to understand the complexities of functional alcoholism and substance use disorders. We evaluate and provide treatment for patients from all over California from the comfort of their homes or office by secure video tele-health appointments. 

In this article, we delve into the DSM-5 criteria for substance use disorders, explore the concept of a “functional alcoholic”, and discuss the role of a psychiatrist in supporting those with addiction.

The DSM-5 Criteria for Substance Use Disorders

Alcohol Use Disorder and Substance Use Disorders, use very similar diagnostic criteria to make a formal diagnosis. Using objective and evidence-based diagnostic criteria is essential in order to have an accurate, objective and verifiable clinical diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines criteria for diagnosing substance use disorders, which include:

1.    Impaired Control: Difficulty in controlling substance use, leading to consumption in larger amounts or over a more extended period than intended and/or trouble cutting back and stopping use. 

2.    Social Impairment: Substance use interferes with and/or negatively impacts social, occupational, or recreational activities and/or negatively impacting relationships. 

3.    Risky Use: Continued substance use despite dangerous situations and/or awareness of recurrent physical or psychological problems caused by or exacerbated by substance use.

4.    Pharmacological Criteria: Tolerance (need for increased amounts for the desired effect) and withdrawal symptoms when substance use is reduced or discontinued.

The Concept of Functional Alcoholism

Functional alcoholism generally refers to individuals who, despite meeting the criteria for an alcohol use disorder, manage to maintain a facade of normalcy in their daily lives. These individuals may hold successful careers, have stable relationships, and seemingly function well, masking the underlying struggle with alcohol. 

Often, being able to temporarily avoid severe negative consequences from their addiction, the “functional alcoholic/addict” may be in denial about the severity of their non-neutral relationship with alcohol/substances and/or the negative consequences that are facing from their untreated addiction. 

Recognizing High Functioning Addiction
There is no prize in being a “functional alcoholic or addict”, the goal in this label is help the individual recognize they have a chronic disease that has evidence-based treatment and good outcomes with proper treatment. The following information hopefully helps an individual suffering from addiction, or their loved ones, better understand the symptoms that are often present and represent signs that help is needed. 

Identifying high functioning addiction involves looking beyond external achievements and a lack of “being drunk and falling down in the gutter”. Signs include:

Increased Tolerance: Needing more of the substance over time to achieve the same effect.

Withdrawal Symptoms: Experiencing physical or psychological symptoms when not using the substance.

Secrecy and Isolation: Engaging in substance use in secret or withdrawing from social interactions.

Failed Attempts to Quit: Unsuccessful attempts to cut down or quit substance use.

The Psychiatrist's Role in Treating Addiction

Comprehensive Assessment: A thorough psychiatric and substance use disorder evaluation to understand the extent and impact of the addiction and a full consideration of possible underlying physical and psychological factors.

Personalized Treatment Plans: Tailoring treatment plans that may include therapy, mutual help groups, medication-assisted treatment, coaching or a combination, based on individual needs.

Motivational Enhancement: Utilizing motivational interviewing techniques to enhance an individual's readiness to change.

Dual Diagnosis Treatment: Addressing co-occurring mental health issues that may contribute to substance use and make sobriety and recovery difficult to achieve without being addressed. Trauma, anxiety, depression, grief and loss and loneliness are common co-occurring symptoms that need to be assessed and supported with treatment. 

Support and Monitoring: Providing ongoing support, monitoring progress, and adjusting treatment plans as needed.

If you are a loved one are concerned about alcoholism, addiction, being a functional alcoholic or addict, a well-trained and experience psychiatrist can help get things back on track. This first step is an assessment and getting more information. If you are interested in becoming a new patient, please schedule a time to speak with our practice manager (using the "book online" button above) or call our office today.

References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.

Grant, B. F., & Dawson, D. A. (2017). Introduction to the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research: Current Reviews, 38(1), 37–44.

Heather, N., Adamson, S. J., Raistrick, D., Slegg, G. P., & Barrett, C. A. (2010). Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes. Alcohol and Alcoholism, 45(2), 136–142.

Rehm, J., & Gmel, G. E. (1999). Aggregate time-series regression in the field of alcohol. Journal of Studies on Alcohol, 60(5), 518–524.

Substance Abuse and Mental Health Services Administration. (2020). Treatment Improvement Protocol (TIP) Series 63: Medications for Opioid Use Disorder—TIP 63.