Working hard, drinking harder

When does a glass or two at the end of the day spill over into high-functioning alcoholism? Rob Sharp investigates

After work every day you either go to the pub or return home to crack open a bottle of wine. Twice a week you might drink so much alcohol that you suffer memory loss. You spend much of your time boozing, or planning how you are going to become inebriated. The morning after a hardy session of knocking back shots and downing pints, you go to work as normal, battling with little more than the dehydration, headaches and muscle ache of an average hangover.

If this sounds like a conventional seven-day period to you then you could well need to seek medical help. It might seem like the opposite of the stereotypical image of a problem drinker, but high-functioning alcoholism – addiction to alcohol which seems to have no adverse effects on a person's day-to-day professional life – is a significant national problem. In 2007, the most recent statistics available, 33 per cent of men and 16 per cent of women (24 per cent of adults) were classified as hazardous drinkers by the NHS. Among adults aged 16 to 74, nine per cent of men and four per cent of women showed some signs of alcohol dependence. A large proportion of these people are likely to be suffering from high-functioning alcoholism.

Boston-based Sarah Allen Benton is hardly your stereotypical alcoholic. She has a masters from Northeastern University, also in Boston, and is a licensed mental-health counsellor at the city's Emmanuel College. In recovery from alcoholism for the past five years, her book, Understanding the High-Functioning Alcoholic, published in the US in March, tells of her descent into alcoholism and her subsequent recovery. Benton estimates that at least 50 per cent of all alcoholics are high-functioning types.

"I started drinking at 14, socially, at a party," Benton says. "From the beginning I experienced blackouts and memory lapses. When I did drink I had a problem controlling the intake. I was a binge drinker." The counsellor says that when she moved to college the habit continued, though she had no trouble attending classes on time or achieving good grades. "On the outside, things were looking good," she continues. "But when I drank I would do things which were against my ethics and morals. I didn't think I was an alcoholic, though – I thought that was just old men drinking out of brown paper bags in the street." The author says her drinking – which she says, she regarded as a reward for a hard day's work, much like anybody else – continued when she started to pursue a career in television production.

"I would vomit, I would lose my memory. I would not remember how I got home, and my friends would have to tell me. But I would never let a hangover get in the way of me going to work."

A high-functioning alcoholic (HFA) is clinically defined as someone who is able to maintain their "outside life" – such as job, home, family and friendships, all while drinking alcoholically. HFAs have the same disease as "skid-row" alcoholics, but the disease manifests itself differently. Many HFAs are not viewed by society as being alcoholic because they have succeeded in their careers and personal lives. These achievements often lead the HFAs to deny they have a problem; they are less likely to feel they need treatment for alcoholism, and may slide through the cracks in the healthcare system because they are not diagnosed. Additionally, problems with alcohol withdrawal are usually a major tell-tale sign during the diagnosis for alcohol dependence; many HFAs are neither daily drinkers nor physically addicted to alcohol.

According to Alcoholics Anonymous, it is easier to characterise in other ways. Such as, for example, when an individual experiences a craving for drink, or when someone behaves out of character when inebriated. The risks involved in being an HFA may include dangerous behaviours such as drinking and driving, having risky sexual encounters, or blacking out.

Benton says she ultimately managed to wean herself off alcohol by enrolling in a recovery programme similar to Alcoholics Anonymous. "It's vital to have a social support system which might feature therapy at times," she says. "Weaning yourself off alcohol can also be accompanied by anxiety and depression, and these need to be treated. I haven't had a drink in five years. The most important step I went through was accepting that I might be an alcoholic, despite contradicting the conventional stereotype."

Her advice is simple. "I would say: try to control it. Try to set goals or limit the number of drinks you have in an evening. See if you can adhere to those limits. I couldn't, even for a couple of days, and would return to my old ways. I needed treatment, and many people are in a similar situation – missing out on important life lessons because they only know how to deal with things through drink. People in dead marriages, for example. It gives people a false sense of security and prevents them from addressing other problems."

High-functioning alcoholism: the signs

* You have trouble controlling your intake even after deciding that you will drink no more than a given amount.

* You find yourself thinking obsessively about drinking — when and where and with whom you will drink next.

* When you drink, you behave in ways that are uncharacteristic of your sober self.

* You experience blackouts, and are unable to remember what took place during a drinking bout.